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Abstract
ObjectivesTo determine whether quantitative wall motion assessment by CMR myocardial feature tracking (CMR-FT) would reduce the impact of observer experience as compared to visual analysis in patients with ischemic cardiomyopathy (ICM).Methods15 consecutive patients with ICM referred for assessment of hibernating myocardium were studied at 3 Tesla using SSFP cine images at rest and during low dose dobutamine stress (5 and 10 μg/kg/min of dobutamine). Conventional visual, qualitative analysis was performed independently and blinded by an experienced and an inexperienced reader, followed by post-processing of the same images by CMR-FT to quantify subendocardial and subepicardial circumferential (Eccendo and Eccepi) and radial (Err) strain. Receiver operator characteristics (ROC) were assessed for each strain parameter and operator to detect the presence of inotropic reserve as visually defined by the experienced observer.Results141 segments with wall motion abnormalities at rest were eligible for the analysis. Visual scoring of wall motion at rest and during dobutamine was significantly different between the experienced and the inexperienced observer (p<0.001). All strain values (Eccendo, Eccepi and Err) derived during dobutamine stress (5 and 10 μg/kg/min) showed similar diagnostic accuracy for the detection of contractile reserve for both operators with no differences in ROC (p>0.05). Eccendo was the most accurate (AUC of 0.76, 10 μg/kg/min of dobutamine) parameter. Diagnostic accuracy was worse for resting strain with differences between operators for Eccendo and Eccepi (p<0.05) but not Err (p>0.05).ConclusionWhilst visual analysis remains highly dependent on operator experience, quantitative CMR-FT analysis of myocardial wall mechanics during DS-CMR provides diagnostic accuracy for the detection of inotropic reserve regardless of operator experience and hence may improve diagnostic robustness of low-dose DS-CMR in clinical practice.
Highlights
Cardiovascular magnetic resonance (CMR) plays an important role in the routine clinical management of patients with coronary artery disease (CAD)
Visual scoring of wall motion at rest and during dobutamine was significantly different between the PLOS ONE | DOI:10.1371/journal.pone
Whilst visual analysis remains highly dependent on operator experience, quantitative CMRFT analysis of myocardial wall mechanics during dobutamine stress (DS)-CMR provides diagnostic accuracy for the detection of inotropic reserve regardless of operator experience and may improve diagnostic robustness of low-dose DS-CMR in clinical practice
Summary
Cardiovascular magnetic resonance (CMR) plays an important role in the routine clinical management of patients with coronary artery disease (CAD). Its utility is increasing as it provides an assessment of myocardial function, hibernating myocardium and perfusion in a single examination [1,2,3]. CMR is considered the reference standard for wall motion analysis. It allows the visualization of left ventricular (LV) endocardial wall motion at rest, as well as during low and high dose dobutamine stress (DS) to assess myocardial hibernation and ischemia [3]. The diagnostic accuracy of qualitative assessment (i.e. visual assessment) has been shown to be considerably operator dependent [4]. Myocardial tagging allows for quantitative assessment but requires the acquisition of additional tagging sequences and post processing [5, 6]
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