Displacement encoding with stimulated echoes enables the identification of infarct transmurality early postmyocardial infarction

Mangion, K. et al. (2020) Displacement encoding with stimulated echoes enables the identification of infarct transmurality early postmyocardial infarction. Journal of Magnetic Resonance Imaging, 52(6), pp. 1722-1731. (doi: 10.1002/jmri.27295) (PMID:32720405)

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Abstract

Background Segmental extent of infarction assessed by late gadolinium enhancement (LGE) imaging early post‐ST‐segment elevation myocardial infarction (STEMI) has utility in predicting left ventricular functional recovery. Hypothesis: We hypothesized that segmental circumferential strain with displacement encoding with stimulated echoes (DENSE) would be a stronger predictor of infarct transmurality than feature‐tracking strain, and noninferior to extracellular volume fraction (ECV). Study Type: Prospective. Population: Fifty participants (mean ± SD, 59 ± 9 years, 40 [80%] male) underwent cardiac MRI on day 1 post‐STEMI. Field‐Strength/Sequences: 1.5T/cine, DENSE , T1 mapping, ECV , LGE. Assessment Two observers assessed segmental percentage LGE extent, presence of microvascular obstruction (MVO), circumferential and radial strain with DENSE and feature‐tracking, T1 relaxation times, and ECV. Statistical Tests: Normality was tested using the Shapiro–Wilk test. Skewed distributions were analyzed utilizing Mann–Whitney or Kruskal–Wallis tests and normal distributed data using independent t ‐tests. Diagnostic cutoff values were identified using the Youden index. The difference in area under the curve was compared using the z‐statistic. Results: Segmental circumferential strain with DENSE was associated with the extent of infarction ≥50% (AUC [95% CI], cutoff value = 0.9 [0.8, 0.9], −10%) similar to ECV (AUC = 0.8 [0.8, 0.9], 37%) (P = 0.117) and superior to feature‐tracking circumferential strain (AUC = 0.7[0.7, 0.8], −19%) (P  < 0.05). For the detection of segmental infarction ≥75%, circumferential strain with DENSE (AUC = 0.9 [0.8, 0.9], −10%) was noninferior to ECV (AUC = 0.8 [0.7, 0.9], 42%) (P = 0.132) and superior to feature‐tracking (AUC = 0.7 [0.7, 0.8], −13%) (P  < 0.05). For MVO detection, circumferential strain with DENSE (AUC = 0.8 [0.8, 0.9], −12%) was superior to ECV (AUC = 0.8 [0.7, 0.8] 34%) (P  < 0.05) and feature‐tracking (AUC = 0.7 [0.6, 0.7] −21%) (P  < 0.05). Data Conclusion: Circumferential strain with DENSE is a functional measure of infarct severity and may remove the need for gadolinium contrast agents in some circumstances. Level of Evidence: 2 Technical Efficacy Stage: 5

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and Shaukat, Dr Aadil and Rocchiccioli, Dr John and Lee, Matthew and Mccomb, Dr Christie and McEntegart, Dr Margaret and Eteiba, Dr Hany and Corcoran, Dr David and Loughrey, Professor Christopher and Mangion, Dr Kenneth and Haig, Dr Caroline and Hood, Dr Stuart
Authors: Mangion, K., Loughrey, C., Auger, D. A., McComb, C., Lee, M. M., Corcoran, D., McEntegart, M., Davie, A., Good, R., Lindsay, M., Eteiba, H., Rocchiccioli, J. P., Watkins, S., Hood, S., Shaukat, A., Haig, C., Epstein, F. H., and Berry, C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Journal of Magnetic Resonance Imaging
Publisher:Wiley
ISSN:1053-1807
ISSN (Online):1522-2586
Published Online:27 July 2020
Copyright Holders:Copyright © 2020 The Authors
First Published:First published in Journal of Magnetic Resonance Imaging 52(6): 1722-1731
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
167523Investigating the therapeutic potential of cathepsin-L inhibition to limit ischaemia-reperfusion injury in the heartChristopher LoughreyChief Scientist Office (CSO)ETM/263Institute of Cardiovascular & Medical Sciences
172173Myocardial strain measurements in survivors of acute ST-elevation myocardial infarction: implementation and prognostic significance of novel magnetic resonance imaging methods.Colin BerryBritish Heart Foundation (BHF)FS/15/54/31639Institute of Cardiovascular & Medical Sciences
190814BHF centre of excellenceRhian TouyzBritish Heart Foundation (BHF)RE/13/5/30177Institute of Cardiovascular & Medical Sciences