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

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.

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

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
M. Polacin ◽  
M. Karolyi ◽  
M. Eberhard ◽  
A. Gotschy ◽  
B. Baessler ◽  
...  
Keyword(s):  
Wall Motion ◽  
Circumferential Strain ◽  
Radial Strain ◽  
Scar Tissue ◽  
Remote Myocardium ◽  
Short Axis ◽  
Short Axis Cine ◽  
Global Strain ◽  
Motion Assessment ◽  
Global Peak

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.

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

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.

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

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.

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

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
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.

Abstract 15755: Adverse Cardiac Remodeling in Obese Children

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Aparna Kulkarni ◽  
Jose Miguel Mateo D Lorenzo ◽  
Talin Gulesserian ◽  
Frederick Kaskel ◽  
Joseph Mahgerefteh
Keyword(s):  
Strain Rate ◽  
Cardiac Remodeling ◽  
Longitudinal Strain ◽  
Circumferential Strain ◽  
Global Longitudinal Strain ◽  
Radial Strain ◽  
Volume Ratio ◽  
Obese Children ◽  
Z Scores ◽  
Doppler Indices

Background: Obesity (OB) and hypertension (HTN) are risk factors for early cardiovascular disease (CVD). The aim of this study was to determine the effect of OB and HTN on myocardial mechanics in children using speckle-tracking echocardiography (STE). Methods: Echocardiograms (echo) and ambulatory blood pressure monitors were performed in children referred for HTN from 2009 to 2014. Traditional echo Doppler indices, mass and volume parameters, 24-hr systolic blood pressures (24SBP) and 24-hr diastolic BP indices were obtained. Post-processing was performed on the 2D gray scale images of LV in apical 4-chamber and parasternal short axis mid-papillary views to obtain strain indices (Image Arena, Tomtec). Associations of obesity and BP to the myocardial indices were explored independently using Spearman correlation coefficient. Results: Among 107 patients, 6 - 21 yrs age, 79.4% were males; 42% OB and 53% were hypertensive. Mean Z scores for BMI were 1.5 ± 1.1 and SBP were 1.5 ± 1.2. Mean LV mass (LVM, 2D area-length) was 131 + 42.8 gms, LVMI 2.7 was 40.7 + 9.6 gms, LVM/volume ratio was 0.94 + 0.17. Mean mitral septal E/e’ was 8.3 + 2.1, lateral E/e’ was 5.9 + 1.5 and mitral E/A ratio was 1.8 + 0.4. The mean global longitudinal strain (GLS) was – 17.7 + 3.6, global circumferential strain (GCS) was -20.4 + 3.8, average radial strain (ARS) was 22 + 11.9, average longitudinal strain rate (ALSR) was -1.0 + 0.35 and average circumferential strain rate (ACSR) was -1.5 + 0.5 for all patients. BMI Z scores positively correlated with LVM (r=0.38, p<0.01), LVM/vol (r=0.32, p<0.01), mitral E/e’ (r=0.28, p<0.01), LVMI 2.7 (r=0.5, <0.01). Increased BMI negatively correlated to GLS, GCS and ACSR (r=0.3, p<0.01). Higher SBP, diastolic and mean BP were associated with higher mitral medial E/e’ (r=0.3, p<0.01), however did not have statistically significant correlations to strain indices. Conclusions: Obesity causes adverse cardiac remodeling in obese children. This may provide insights into mechanisms of long-term CV effects of obesity. Myocardial effects of HTN were not apparent, possibly due to heterogeneity of the study group and low power.

Stress Cardiac Magnetic Resonance Imaging

2018 ◽  
pp. 335-343
Author(s):  
Yeonyee E. Yoon ◽  
L. Samuel Wann
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Myocardial Perfusion ◽  
Cardiac Magnetic Resonance Imaging ◽  
Wall Motion ◽  
Scar Tissue ◽  
Resonance Imaging ◽  
Stress Cardiac Magnetic Resonance ◽  
Myocardial Thickening

The chapter Stress Cardiac Magnetic Resonance Imaging reviews how cardiovascular magnetic resonance imaging (CMR) has become a gold standard for evaluating stress induced wall motion abnormalities based on regional endocardial excursion and myocardial thickening. The high spatial and temporal resolution of CMR without limitations imposed by body habitus and acoustic windows allows outstanding visualization of myocardial function. CMR can also be combined with vasodilator stress to perform dynamic first-pass myocardial perfusion imaging. The addition of late gadolinium enhancement allows the accurate of nonviable scar tissue in combination with wall motion and myocardial perfusion assessment. Case studies highlight the opportunity provided by stress CMR.

scholarly journals Clinical validation of three cardiovascular magnetic resonance techniques to measure strain and torsion in patients with suspected coronary artery disease

2020 ◽  
Vol 22 (1) ◽  
Author(s):  
Johan Kihlberg ◽  
Vikas Gupta ◽  
Henrik Haraldsson ◽  
Andreas Sigfridsson ◽  
Sebastian I. Sarvari ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Cardiovascular Magnetic Resonance ◽  
Coronary Artery ◽  
Magnetic Resonance ◽  
Circumferential Strain ◽  
Myocardial Strain ◽  
Radial Strain ◽  
Left Ventricular ◽  
Operating Characteristics ◽  
Artery Disease

Abstract Background Several cardiovascular magnetic resonance (CMR) techniques can measure myocardial strain and torsion with high accuracy. The purpose of this study was to compare displacement encoding with stimulated echoes (DENSE), tagging and feature tracking (FT) for measuring circumferential and radial myocardial strain and myocardial torsion in order to assess myocardial function and infarct scar burden both at a global and at a segmental level. Method 116 patients with a high likelihood of coronary artery disease (European SCORE > 15%) underwent CMR examination including cine images, tagging, DENSE and late gadolinium enhancement (LGE) in the short axis direction. In total, 97 patients had signs of myocardial disease and 19 had no abnormalities in terms of left ventricular (LV) wall mass index, LV ejection fraction, wall motion, LGE or a history of myocardial infarction. Thirty-four patients had myocardial infarct scar with a transmural LGE extent (transmurality) that exceeded 50% of the wall thickness in at least one segment. Global circumferential strain (GCS) and global radial strain (GRS) was analyzed using FT of cine loops, deformation of tag lines or DENSE displacement. Results DENSE and tagging both showed high sensitivity (82% and 71%) at a specificity of 80% for the detection of segments with > 50% LGE transmurality, and receiver operating characteristics (ROC) analysis showed significantly higher area under the curve-values (AUC) for DENSE (0.87) than for tagging (0.83, p < 0.001) and FT (0.66, p = 0.003). GCS correlated with global LGE when determined with DENSE (r = 0.41), tagging (r = 0.37) and FT (r = 0.15). GRS had a low but significant negative correlation with LGE; DENSE r = − 0.10, FT r = − 0.07 and tagging r = − 0.16. Torsion from DENSE and tagging had a weak correlation (− 0.20 and − 0.22 respectively) with global LGE. Conclusion Circumferential strain from DENSE detected segments with > 50% scar with a higher AUC than strain determined from tagging and FT at a segmental level. GCS and torsion computed from DENSE and tagging showed similar correlation with global scar size, while when computed from FT, the correlation was lower.

Functional implications of myocardial scar structure

1997 ◽  
Vol 272 (5) ◽  
pp. H2123-H2130 ◽  
Author(s):  
J. W. Holmes ◽  
J. A. Nunez ◽  
J. W. Covell
Keyword(s):  
Collagen Fiber ◽  
Circumferential Strain ◽  
Important Determinant ◽  
Scar Tissue ◽  
Collagen Fibers ◽  
Myocardial Scar ◽  
Radial Deformation ◽  
Fiber Structure ◽  
Coronary Ligation ◽  
Functional Implications

During healing after myocardial infarction, scar collagen content and stiffness do not correlate. We studied regional mechanics and both area fraction and orientation of large collagen fibers 3 wk after coronary ligation in the pig. During passive inflation of isolated, arrested hearts, the scar tissue demonstrated significantly less circumferential strain but similar longitudinal and radial deformation in comparison with noninfarcted regions of the same hearts. The observed selective resistance to circumferential deformation was consistent with the finding that most of the large collagen fibers in the scar were oriented within 30 degrees of the local circumferential axis. Furthermore, data from a previous study indicate that during ventricular systole these scars resist circumferential stretching, whereas they deform similarly to noninfarcted myocardium in the longitudinal and radial directions. We conclude that large collagen fiber structure is an important determinant of scar mechanical properties and that scar anisotropy allows the scar to resist circumferential stretching while deforming compatibly with adjacent noninfarcted myocardium in the longitudinal and radial directions.

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