Predictors of segmental myocardial functional recovery in patients after an acute ST-Elevation myocardial infarction

Abstract

Objective We hypothesized that Displacement Encoding with Stimulated Echoes (DENSE) and feature-tracking derived circumferential strain would provide incremental prognostic value over the extent of infarction for recovery of segmental myocardial function. Methods Two hundred and sixty-one patients (mean age 59 years, 73% male) underwent MRI 2 days post-ST elevation myocardial infarction (STEMI) and 241 (92%) underwent repeat imaging 6 months later. The MRI protocol included cine, 2D-cine DENSE, T2 mapping and late enhancement. Wall motion scoring was assessed by 2-blinded observers and adjudicated by a third. (WMS: 1=normal, 2=hypokinetic, 3=akinetic, 4=dyskinetic). WMS improvement was defined as a decrease in WMS ≥ 1, and normalization where WMS = 1 on follow-up. Segmental circumferential strain was derived utilizing DENSE and feature-tracking. A generalized linear mixed model with random effect of subject was constructed and used to account for repeated sampling when investigating predictors of segmental myocardial improvement or normalization Results At baseline and follow-up, 1416 segments had evaluable data for all parameters. Circumferential strain by DENSE (p < 0.001) and feature-tracking (p < 0.001), extent of oedema (p < 0.001), infarct size (p < 0.001), and microvascular obstruction (p < 0.001) were associates of both improvement and normalization of WMS. Circumferential strain provided incremental predictive value even after accounting for infarct size, extent of oedema and microvascular obstruction, for segmental improvement (DENSE: odds ratio, 95% confidence intervals: 1.08 per −1% peak strain, 1.05–1.12, p < 0.001, feature-tracking: odds ratio, 95% confidence intervals: 1.05 per −1% peak strain, 1.03–1.07, p < 0.001) and segmental normalization (DENSE: 1.08 per −1% peak strain, 1.04–1.12, p < 0.001, feature-tracking: 1.06 per −1% peak strain, 1.04–1.08, p < 0.001). Conclusions Circumferential strain provides incremental prognostic value over segmental infarct size in patients post STEMI for predicting segmental improvement or normalization by wall-motion scoring.

Left ventricular functional recovery of infarcted and remote myocardium after ST-segment elevation myocardial infarction (METOCARD-CNIC randomized clinical trial substudy)

“…Global LV longitudinal strain and circumferential strain with featuretracking CMR have provided important prognostic information after myocardial infarction [7,8]. On the other hand, regional LV deformation has been mostly studied in small single-center studies with different CMR tissue tracking techniques, such as myocardial tagging, strain encoded (SENC) imaging, displacement encoding with stimulated echoes (DENSE) imaging or feature-tracking [9][10][11][12][13][14][15]. However, the evolution of LV strain after a ST-segment elevation myocardial infarction (STEMI) within infarcted and remote myocardium has not yet been investigated with featuretracking CMR.…”

A poroelastic immersed finite element framework for modelling cardiac perfusion and fluid–structure interaction

“…We evaluate the fibre strain using two different methods, one being with respect to early diastole (the reference geometry), denoted as E ff , and the other with respect to end diastole, denoted as . Although the former is more natural for computational modelling, the latter is more commonly used in clinical settings 35,37 . Using both models, similar trends are seen in the stress and strain distributions.…”

Displacement Encoding With Stimulated Echoes Enables the Identification of Infarct Transmurality Early Postmyocardial Infarction

“…Myocardial strain has the potential to provide new insights into the pathophysiology of STEMI. [7][8][9][10][11] The advantages of quantitative methods beyond the left ventricular ejection fraction (LVEF) and wall-motion scoring include improved diagnostic sensitivity and specificity, less interobserver and intraobserver variability, and novel parameters of biomechanical function. 7 Displacement encoding with stimulated echoes (DENSE) has advantages over tagging, which is historically regarded as the gold standard technique for cardiac magnetic resonance imaging (MRI)-derived strain.…”

“…Myocardial strain has the potential to provide new insights into the pathophysiology of STEMI 7–11 . The advantages of quantitative methods beyond the left ventricular ejection fraction (LVEF) and wall‐motion scoring include improved diagnostic sensitivity and specificity, less interobserver and intraobserver variability, and novel parameters of biomechanical function 7 …”

“…Furthermore, the time required to perform strain analysis of DENSE images is less than that for conventional tagging analysis 19 . Studies previously demonstrated that DENSE‐derived global circumferential strain had incremental benefit over acute infarct size to predict major adverse cardiac events, and segmental circumferential strain with DENSE provided incremental utility over the segmental extent of infarction to predict myocardial functional recovery by wall‐motion scoring 10,11 . Further work needs to be carried out to assess if DENSE can obviate the use of gadolinium contrast agents in patients postmyocardial infarction.…”