Strain-Encoded CMR for the Detection of Inducible Ischemia During Intermediate Stress

Korosoglou, Grigorios; Lehrke, Stephanie; Wochele, Angela; Hoerig, Birgit; Loßnitzer, Dirk; Steen, Henning; Giannitsis, Evangelos; Osman, Nael F.; Katus, Hugo A.

doi:10.1016/j.jcmg.2009.11.015

Cited by 73 publications

(74 citation statements)

References 21 publications

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“…A number of different parameters derived from the SR 22 signal have been proposed, 66,109 and the value of the negative peak between aortic valve opening and closing has been used the most often. 66,[86][87][88]94 The sensitivity of Peak SR 22 to demand ischemia has been shown to be limited in some studies in vivo, 66,94 which is consistent with our model results. The measurement of strain rate with speckle tracking has become more common, making measurement of Peak SR 11 feasible clinically, and this model indicates that using Peak SR 11 may be better for detecting abnormal function.…”

Section: Comparison To Previous Studiessupporting

confidence: 89%

“…Previous studies have shown conflicting results in comparing circumferential and longitudinal strain for diagnosis of dobutamine-induced ischemia; some studies show circumferential strain to be superior to longitudinal, 93 while others claim they are diagnostically equivalent. 65,94 Longitudinal strain was often used in the past because it was easier to measure with tissue Doppler imaging than circumferential strain. A detailed study of strains measured with radiopaque beads in dogs during brief coronary occlusion at rest showed that the amount of endocardial and midwall dyskinesis after 5 minutes of ischemia is similar in the longitudinal and circumferential directions, and the change in endocardial strain from control to ischemia was 0.19 ± 0.08 in the circumferential direction and 0.16 ± 0.06 in the longitudinal direction.…”

Section: Strain Analysismentioning

confidence: 99%

“…66,94,109 Longitudinal strain rate is most often reported because it is the easiest parameter to measure with tissue Doppler. However, in this study we found that peak systolic circumferential strain rate was more specific for detecting CFR<1.1 than longitudinal strain rate.…”

Section: Strain Rate Measured By Tissue Doppler Imaging Is Another Comentioning

confidence: 99%

“…Fractional shortening measured from two-dimensional echocardiography was reported to increase at intermediate stress 131 and not change at peak stress 135 compared with rest. In a clinical population, longitudinal and circumferential strain have been reported to both increase in magnitude 93 and not change 67,94 with stress, while strain rate magnitude has been reported to increase with stress. 66,67,94 EF, fractional shortening, and strain are normalized by diastolic values, and can be confusing to interpret when these diastolic values change.…”

Section: Introductionmentioning

confidence: 97%

“…Most research studies use one imaging modality to report one or two measures, and the sum of this literature can produce conflicting results. For example, for detecting coronary artery disease (CAD) from stress echocardiography, various studies have found that circumferential strain performs better than longitudinal and radial strain, 93 circumferential and longitudinal strain perform better than radial strain, 65 strain rate performs better than systolic strain 66,94 but worse than post-systolic strain, 66 and peak systolic strain rate from 2D speckle tracking performs better than tissue Doppler. 67 While interesting comparisons, it can be difficult to translate results between studies as the data are collected from different imaging modalities, at different locations in the heart and with different sources or error.…”

Section: Introductionmentioning

confidence: 99%

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Regional Mechanics of Demand Ischemia During Cardiac Stress Testing

Parker

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Currently, the most effective non-invasive method for early diagnosis of coronary artery disease is the cardiac stress test. In this test, stress is induced by treadmill exercise or with a pharmacologic agent such as dobutamine, and myocardium with insufficient coronary flow reserve, usually caused by coronary stenosis, experiences an imbalance between oxygen supply and demand known as demand ischemia. This causes altered mechanical and electrical behavior that is often identified using cardiac imaging. The mechanical movement of the left ventricular (LV) wall, characterized clinically as "wall motion", is currently assessed qualitatively to identify abnormally-moving ischemic regions which may benefit from angioplasty. Advances in ultrasound and MRI may improve diagnosis by allowing more quantitative measures such as strain, wall thickening, or endocardial fractional shortening. However, little is understood about how these measures are affected by the severity of demand ischemia, coupling to adjacent myocardium, or the presence of previously-unrecognized myocardial infarction. A greater understanding of the factors that influence regional mechanics during stress testing would help determine the best way to detect the altered mechanics that indicate demand ischemia and coronary stenosis. The goal of this dissertation is to understand how regional demand ischemia affects regional mechanics and apply that knowledge to improve clinical stress testing.A finite element model of the heart was used to examine how reduced force generation in the ischemic region, ischemic region size, and coupling to myocardium with increased contractility separately and jointly impact various measures of regional mechanics. Area strain and a measure of wall motion developed in our lab, threeiv dimensional fractional shortening (3DFS), were most sensitive to reduced force generation, while radial strain was affected most by the contractility of remote myocardium. The model also predicted that a novel measure of wall motion bulging, dyskinesia severity index (DSI), can separate infarcts from demand ischemia during stress testing. The ability of strain and 3DFS to detect a critical stenosis was evaluated in experimental canine dobutamine stress tests. The three-dimensional (3D) measures of area strain and 3DFS detected critical stenoses better than two-dimensional (2D) strain. Finally, 3DFS measured during clinical stress testing in patients at low risk for coronary artery disease displayed low variability, suggesting 3DFS may be effective for detecting demand ischemia in patients.Another application in which the cardiac mapping techniques described here could improve treatment is in evaluating cardiac resynchronization therapy (CRT) nonresponders, which compromise 30-40% of CRT patients. The relationship between LV lead location and scar or regional mechanical function measured from pre-CRT cardiac imaging likely has an important impact on CRT response. A method to reconstruct the 3D coordinates of the lead from 2D fluoroscopic i...

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Section: Comparison To Previous Studiessupporting

confidence: 89%

Section: Strain Analysismentioning

confidence: 99%

Section: Strain Rate Measured By Tissue Doppler Imaging Is Another Comentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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Regional Mechanics of Demand Ischemia During Cardiac Stress Testing

Parker

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CMR to Assess Morphology, Function, Perfusion, and Viability

Gupta

Sharifov

Kim³

et al. 2019

Cardiac CT, PET &Amp; MR

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Strain‐encoded magnetic resonance: a method for the assessment of myocardial deformation

Korosoglou¹,

Giuşcă²,

Hofmann³

et al. 2019

ESC Heart Failure

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This study aims to assess the usefulness of strain‐encoded magnetic resonance (SENC) for the quantification of myocardial deformation (‘strain’) in healthy volunteers and for the diagnostic workup of patients with different cardiovascular pathologies. SENC was initially described in the year 2001. Since then, the SENC sequence has undergone several technical developments, aiming at the detection of strain during single‐heartbeat acquisitions (fast‐SENC). Experimental and clinical studies that used SENC and fast‐SENC or compared SENC with conventional cine or tagged magnetic resonance in phantoms, animals, healthy volunteers, or patients were systematically searched for in PubMed. Using ‘strain‐encoded magnetic resonance and SENC’ as keywords, three phantom and three animal studies were identified, along with 27 further clinical studies, involving 185 healthy subjects and 904 patients. SENC (i) enabled reproducible assessment of myocardial deformation in vitro, in animals and in healthy volunteers, (ii) showed high reproducibility and substantially lower time spent compared with conventional tagging, (iii) exhibited incremental value to standard cine imaging for the detection of inducible ischaemia and for the risk stratification of patients with ischaemic heart disease, and (iv) enabled the diagnostic classification of patients with transplant vasculopathy, cardiomyopathies, pulmonary hypertension, and diabetic heart disease. SENC has the potential to detect a wide range of myocardial diseases early, accurately, and without the need of contrast agent injection, possibly enabling the initiation of specific cardiac therapies during earlier disease stages. Its one‐heartbeat acquisition mode during free breathing results in shorter cardiovascular magnetic resonance protocols, making its implementation in the clinical realm promising.

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Strain-Encoded CMR for the Detection of Inducible Ischemia During Intermediate Stress

Cited by 73 publications

References 21 publications

Regional Mechanics of Demand Ischemia During Cardiac Stress Testing

Regional Mechanics of Demand Ischemia During Cardiac Stress Testing

CMR to Assess Morphology, Function, Perfusion, and Viability

Strain‐encoded magnetic resonance: a method for the assessment of myocardial deformation

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