Segmental strain analysis for the detection of chronic ischemic scars in non-contrast cardiac MRI cine images

AbstractCardiac magnetic resonance imaging (MRI) with late gadolinium enhancement (LGE) is considered the gold standard for scar detection after myocardial infarction. In times of increasing skepticism about gadolinium depositions in brain tissue and contraindications of gadolinium administration in some patient groups, tissue strain-based techniques for detecting ischemic scars should be further developed as part of clinical protocols. Therefore, the objective of the present work was to investigate whether segmental strain is noticeably affected in chronic infarcts and thus can be potentially used for infarct detection based on routinely acquired non-contrast cine images in patients with known coronary artery disease (CAD). Forty-six patients with known CAD and chronic scars in LGE images (5 female, mean age 52 ± 19 years) and 24 gender- and age-matched controls with normal cardiac MRI (2 female, mean age 47 ± 13 years) were retrospectively enrolled. Global (global peak circumferential [GPCS], global peak longitudinal [GPLS], global peak radial strain [GPRS]) and segmental (segmental peak circumferential [SPCS], segmental peak longitudinal [SPLS], segmental peak radial strain [SPRS]) strain parameters were calculated from standard non-contrast balanced SSFP cine sequences using commercially available software (Segment CMR, Medviso, Sweden). Visual wall motion assessment of short axis cine images as well as segmental circumferential strain calculations (endo-/epicardially contoured short axis cine and resulting polar plot strain map) of every patient and control were presented in random order to two independent blinded readers, which should localize potentially infarcted segments in those datasets blinded to LGE images and patient information. Global strain values were impaired in patients compared to controls (GPCS p = 0.02; GPLS p = 0.04; GPRS p = 0.01). Patients with preserved ejection fraction showed also impeded GPCS compared to healthy individuals (p = 0.04). In patients, mean SPCS was significantly impaired in subendocardially (− 5.4% ± 2) and in transmurally infarcted segments (− 1.2% ± 3) compared to remote myocardium (− 12.9% ± 3, p = 0.02 and 0.03, respectively). ROC analysis revealed an optimal cut-off value for SPCS for discriminating infarcted from remote myocardium of − 7.2% with a sensitivity of 89.4% and specificity of 85.7%. Mean SPRS was impeded in transmurally infarcted segments (15.9% ± 6) compared to SPRS of remote myocardium (31.4% ± 5; p = 0.02). The optimal cut-off value for SPRS for discriminating scar tissue from remote myocardium was 16.6% with a sensitivity of 83.3% and specificity of 76.5%. 80.3% of all in LGE infarcted segments (118/147) were correctly localized in segmental circumferential strain calculations based on non-contrast cine images compared to 53.7% (79/147) of infarcted segments detected by visual wall motion assessment (p > 0.01). Global strain parameters are impaired in patients with chronic infarcts compared to controls. Mean SPCS and SPRS in scar tissue is impeded compared to remote myocardium in infarcts patients. Blinded to LGE images, two readers correctly localized 80% of infarcted segments in segmental circumferential strain calculations based on non-contrast cine images, in contrast to only 54% of infarcted segments detected due to wall motion abnormalities in visual wall motion assessment. Analysis of segmental circumferential strain shows a promising method for detection of chronic scars in routinely acquired, non-contrast cine images for patients who cannot receive or decline gadolinium.

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Analysis of Segmental Strain for the Detection of Chronic Ischemic Scars in Non-Contrast Cardiac MRI Cine Images: A Feasibility Study

10.21203/rs.3.rs-125451/v1 ◽

2020 ◽

Author(s):

Malgorzata Polacin ◽

Mihaly Karolyi ◽

Matthias Eberhard ◽

Alexander Gotschy ◽

Bettina Baessler ◽

...

Keyword(s):

Wall Motion ◽

Circumferential Strain ◽

Radial Strain ◽

Scar Tissue ◽

Remote Myocardium ◽

Healthy Individuals ◽

Polar Plot ◽

Global Strain ◽

Motion Assessment ◽

Global Peak

Abstract Aims Cardiac magnetic resonance imaging (MRI) with late gadolinium enhancement (LGE) is considered the gold standard for scar detection after myocardial infarction. In times of increasing skepticism about gadolinium depositions in brain tissue and contraindications of gadolinium administration in some patient groups, tissue strain-based techniques for detecting ischemic scars should be further developed as part of clinical protocols. Therefore, the objective of the present work was to investigate the feasibility of scar detection in segmental strain calculations based on routinely acquired non-contrast cine images in patients with chronic infarcts.Methods Forty-six patients with chronic infarcts and scar tissue in LGE images (5 female, mean age 52 ± 19 years) and 24 gender- and age- matched healthy controls (2 female, mean age 47 ± 13 years) were included. Global (global peak circumferential [GPCS], global peak longitudinal [GPLS], global peak radial strain [GPRS]) and segmental (segmental peak circumferential [SPCS], segmental peak longitudinal [SPLS], segmental peak radial strain [SPRS]) strain parameters were calculated from standard balanced SSFP cine sequences using commercially available software (Segment CMR, Medviso, Sweden). Two independent blinded readers localized potentially infarcted segments in segmental circumferential strain calculations (endo-/epicardially contoured short axis cine and resulting polar plot strain map) and by visual wall motion assessment of cine images. Results Global strain values were reduced in patients compared to controls (GPCS p= 0.02; GPLS p= 0.04; GPRS p= 0.01). Patients with preserved ejection fraction showed also reduced GPCS compared to healthy individuals (p=0.04). In patients, mean SPCS was significantly impaired in subendocardially (- 5,4% +/- 2) and in transmurally infarcted segments (- 1,2% ± 3) compared to remote myocardium (-12,9% +/- 3, p= 0.02 and 0.03, respectively). ROC analysis revealed an optimal cut- off value for SPCS for discriminating infarcted from remote myocardium of - 7,2 % with a sensitivity of 89,4 % and specificity of 85,7%. Mean SPRS was impeded in transmurally infarcted segments (15,9 % +/- 6) compared to SPRS of remote myocardium (31,4% +/- 5; p= 0.02). The optimal cut-off value for SPRS for discriminating scar tissue from remote myocardium was 16,6% with a sensitivity of 83,3% and specificity of 76,5%. 80.3 % of all in LGE infarcted segments (118/147) were correctly localized in segmental circumferential strain calculations based on non-contrast cine images compared to 53.7% (79/147) of infarcted segments detected by visual wall motion assessment (p > 0.01). Conclusion Global strain parameters are impaired in patients with chronic infarcts compared to healthy individuals. Mean SPCS and SPRS in scar tissue is impeded compared to remote myocardium in infarcts patients. Blinded to LGE images, two readers correctly localized 80% of infarcted segments in segmental circumferential strain calculations based on non-contrast cine images, in contrast to only 54% of infarcted segments detected by visual wall motion assessment. Analysis of segmental circumferential strain shows a promising alternative for scar detection based on routinely acquired, non-contrast cine images for patients who cannot receive or decline gadolinium.

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Segmental Strain for Myocardial Scar Detection in Acute Infarcts and Follow-Up CMR Using Non-Contrast Cine Images

10.21203/rs.3.rs-594409/v1 ◽

2021 ◽

Author(s):

Malgorzata Polacin ◽

Mihaly Karolyi ◽

Matthias Eberhard ◽

Alexander Gotschy ◽

Ioannis Matziris ◽

...

Keyword(s):

Wall Motion ◽

Circumferential Strain ◽

Radial Strain ◽

Short Axis ◽

Short Axis Cine ◽

Polar Plot ◽

Global Strain ◽

Motion Assessment ◽

Global Peak

Abstract Aims Scar tissue from myocardial infarction is best visualized with cardiac magnetic resonance (CMR) late gadolinium enhancement (LGE). Gadolinium-free alternatives for detection of myocardial scars are limited. This study investigated the feasibility of myocardial scar detection in acute infarcts and follow-up CMR using non-contrast cine images. Methods Fifty-seven patients with acute infarcts (15 female, mean age 61 ± 12 years, CMR 2.8 ± 2 days after infarction) were retrospectively evaluated with follow-up CMR exams available in thirty-two patients (9 female, 35 ± 14 days after infarction). Twenty-eight patients with normal CMR scans (2 female, mean age 47 ± 8 years) served as controls. Global and segmental strain parameters (global peak circumferential [GPCS], global peak longitudinal [GPLS], global peak radial strain [GPRS], segmental peak circumferential [SPCS], segmental peak longitudinal [SPLS], and segmental peak radial strain [SPRS]) were calculated from standard non-contrast balanced SSFP cine sequences using commercially available software (Segment CMR, Medviso, Sweden). Visual assessment of wall motion abnormalities on short axis cine images, as well as segmental circumferential strain calculations (endo-/epicardially contoured short axis cine and resulting polar plot strain map) of every patient (acute imaging and follow-up CMR) and control were presented for two blinded readers in random order, who were advised to localize potentially infarcted segments, blinded to LGE images and clinical information.Results While global strain values were impaired in patients with acute infarcts compared to controls (GPCS p= 0.01; GPLS p= 0.04; GPRS p= 0.01), global strain was similar between first CMR and follow-up imaging in the subgroup of 32 patients (GPCS p= 0.7; GPLS p=0.8; GPRS p=0.2). In acute infarcts and in follow-up CMR, patients had reduced mean SPCS in infarcted segments compared to remote myocardium (acute p= 0.03, follow-up exams p= 0.02). SPCS values in infarcted areas were similar in acute infarcts and in follow-up exams (p=0.8). In acute infarcts 74.6% of all in LGE infarcted segments (141/189) were correctly localized in polar plot strain maps compared to 44.4% (84/189) of infarcted segments detected by visual wall motion assessment only (p < 0.01). In follow-up exams, 81.5% of all in LGE infarcted segments (93/114 segments) were correctly localized in polar plot strain maps compared to 51.8% (59/114) of infarcted segments detected by visual wall motion assessment (p < 0.01).Conclusion Segmental circumferential strain derived from routinely acquired cine sequences detects nearly 75% acute infarcts and about 80% of infarcts in follow-up CMR and can potentially be used for scar identification based on non-contrast cine images, when gadolinium cant not be applied or LGE images are not available.

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Segmental Strain for Scar Detection in Acute Myocardial Infarcts and in Follow-up Exams using Non-Contrast CMR Cine Sequences

10.21203/rs.3.rs-685378/v1 ◽

2021 ◽

Author(s):

Malgorzata Polacin ◽

Mihaly Karolyi ◽

Matthias Eberhard ◽

Ioannis Matziris ◽

Hatem Alkadhi ◽

...

Keyword(s):

Circumferential Strain ◽

Radial Strain ◽

Clinical Information ◽

Random Order ◽

Short Axis ◽

Visual Evaluation ◽

Peak Longitudinal Strain ◽

And Control ◽

Global Peak

Abstract Background The purpose of the study was to investigate feasibility of infarct detection in segmental strain derived from non-contrast cardiac magnetic resonance (CMR) cine sequences in patients with acute myocardial infarction (AMI) and in follow-up (FU) exams.Methods57 patients with AMI (mean age 61 ± 12 years, CMR 2.8 ± 2 days after infarction) were retrospectively included, FU exams were available in 32 patients (35 ± 14 days after first CMR). 28 patients with normal CMR (47 ± 8 years) served as controls. Dedicated software (Segment CMR, Medviso) was used to calculate global and segmental strain derived from cine sequences. Cine short axis stacks and segmental circumferential strain calculations of every patient and control were presented to two blinded readers in random order, who were advised to identify potentially infarcted segments, blinded to LGE and clinical information. Results Impaired global strain was measured in AMI patients compared to controls (global peak circumferential strain [GPCS] p= 0.01; global peak longitudinal strain [GPLS] p= 0.04; global peak radial strain [GPRS] p= 0.01). In both imaging time points, mean segmental peak circumferential strain [SPCS] was impaired in infarcted tissue compared to remote segments (AMI: p=0.03, FU: p=0.02). SPCS values in infarcted segments were similar between AMI and FU (p=0.8), remote segments were marginally more impaired in AMI than in FU (p= 0.07). In SPCS calculations, 141 from 189 acutely infarcted segments were accurately detected (74.6%), visual evaluation of correlating cine images detected 44.4% infarcts. In FU, 81.5 % infarcted segments (93/114 segments) were detected in SPCS and 51.8% by visual evaluation of correlating short axis cine images (p=0.01).ConclusionSegmental circumferential strain derived from routinely acquired native cine sequences detects nearly 75 % of acute infarcts and about 80% of infarcts in subacute follow-up CMR, significantly more than visual evaluation of correlating cine images alone. Acute infarcts may display only subtle impairment of wall motion and no obvious wall thinning, thus SPCS calculation might be helpful for scar detection in patients with acute infarcts, when only cine images are available.

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Abstract 5736: Diagnosis of Chronic Myocardial Ischemia by Speckle Tacking Echocardiography -A Comparative Animal Study-

Circulation ◽

10.1161/circ.118.suppl_18.s_992-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Koichi Kimura ◽

Katsu Takenaka ◽

Kansei Uno ◽

Aya Ebihara ◽

Katsuhito Fujiu ◽

...

Keyword(s):

Myocardial Ischemia ◽

Strain Rate ◽

Speckle Tracking ◽

Circumferential Strain ◽

Radial Strain ◽

Peak Strain ◽

Short Axis ◽

Short Axis View ◽

Strain And Strain Rate ◽

Axis View

A number of systolic and diastolic indexes for ischemic damage can be measured by 2D speckle tracking echocardiography (STE) including radial strain and strain rate as well as circumferential strain and strain rate on LV short-axis view. In addition, they could be derived from the subendocardium, subepicardium, mid-layer or total layer of the LV wall with new tracking software. The aim of our study is to compare the diagnostic abilities of these indexes in animal experiments. An Ameroid constrictor was placed around the left circumflex coronary artery in 19 pigs. Before and 4 weeks after the surgery, LV short-axis images were obtained at rest by transthoracic 2D echocardiography. Three pigs that had died after the surgery and 2 that had focal infarction in pathological studies were excluded from the study. Thus, in 14 pigs with 99% stenosis on coronary angiograms, we measured peak strain, peak S′, peak E′, time from QRS to peak strain, time from QRS to E′, and incidence of post-systolic shortening (PSS) in the endocardium, midcardium, and epicardium of the LV posterior wall using a new prototype speckle tracking software. None of the time indexes and PSS showed statistically significant results. ROC curve analysis (Table ) revealed that endocardial circumferential strain is the most diagnostic index of ischemia, which showed 79% sensitivity and 93% specificity. Endocardial circumferential strain measured by STE on LV short-axis view was the most useful index for detecting chronic severe myocardial ischemia. Table. Results of measurement in chronic ischemia(mean±SD)

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Comparative Myocardial Deformation in 3 Myocardial Layers in Mice by Speckle Tracking Echocardiography

BioMed Research International ◽

10.1155/2015/148501 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Nicole Tee ◽

Yacui Gu ◽

Murni ◽

Winston Shim

Keyword(s):

High Resolution ◽

Speckle Tracking ◽

Longitudinal Strain ◽

Circumferential Strain ◽

Speckle Tracking Echocardiography ◽

Radial Strain ◽

Myocardial Deformation ◽

Ultrasound Machine ◽

Myocardial Layers ◽

Global Peak

Background. Speckle tracking echocardiography (STE) using dedicated high-resolution ultrasound is a relatively new technique that is useful in assessing myocardial deformation in 3 myocardial layers in small animals. However, comparative studies of STE parameters acquired from murine are limited.Methods. A high-resolution rodent ultrasound machine (VSI Vevo 2100) and a clinically validated ultrasound machine (GE Vivid 7) were used to consecutively acquire echocardiography images from standardized parasternal long axis and short axis at midpapillary muscle level from 13 BALB/c mice. Speckle tracking strain (longitudinal, circumferential, and radial) from endocardial, myocardial, and epicardial layers was analyzed using vendor-specific offline analysis software.Results. Intersystem differences were not statistically significant in the global peak longitudinal strain (−16.8 ± 1.7% versus −18.7 ± 3.1%) and radial strain (46.8 ± 14.2% versus 41.0 ± 9.5%), except in the global peak circumferential strain (−16.9 ± 3.1% versus 27.0 ± 5.2%,P<0.05). This was corroborated by Bland Altman analysis that revealed a weak agreement in circumferential strain (mean bias ± 1.96 SD of −10.12 ± 6.06%) between endocardium and midmyocardium. However, a good agreement was observed in longitudinal strain between midmyocardium/endocardium (mean bias ± 1.96 SD of −1.88 ± 3.93%) and between midmyocardium/epicardium (mean bias ± 1.96 SD of 3.63 ± 3.91%). Radial strain (mean bias ± 1.96 SD of −5.84 ± 17.70%) had wide limits of agreement between the two systems that indicated an increased variability.Conclusions. Our study shows that there is good reproducibility and agreement in longitudinal deformation of the 3 myocardial layers between the two ultrasound systems. Directional deformation gradients at endocardium, myocardium, and epicardium observed in mice were consistent to those reported in human subjects, thus attesting the clinical relevance of STE findings in murine cardiovascular disease models.

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