Abstract
ObjectivesThe aim of the present study was to evaluate the diagnostic performances of strain and wall thickening analysis in discriminating among three types of myocardium after acute myocardial infarction: non-infarcted myocardium, infarcted myocardium without microvascular obstruction (MVO) and infarcted myocardium with MVO.MethodsSeventy-one patients with a successfully treated ST-segment elevation myocardial infarction underwent cardiovascular magnetic resonance imaging at 2-6 days after reperfusion. The imaging protocol included conventional cine imaging, myocardial tissue tagging and late gadolinium enhancement. Regional circumferential and radial strain and associated strain rates were analyzed in a 16-segment model as were the absolute and relative wall thickening.ResultsHyperenhancement was detected in 418 (38%) of 1096 segments and was accompanied by MVO in 145 (35%) of hyperenhanced segments. Wall thickening, circumferential and radial strain were all significantly diminished in segments with hyperenhancement and decreased even further if MVO was also present (all p < 0.001). Peak circumferential strain (CS) surpassed all other strain and wall thickening parameters in its ability to discriminate between hyperenhanced and non-enhanced myocardium (all p < 0.05). Furthermore, CS was superior to both absolute and relative wall thickening in differentiating infarcted segments with MVO from infarcted segments without MVO (p = 0.02 and p = 0.001, respectively).ConclusionsStrain analysis is superior to wall thickening in differentiating between non-infarcted myocardium, infarcted myocardium without MVO and infarcted myocardium with MVO. Peak circumferential strain is the most accurate marker of regional function.Key Points• CMR can quantify regional myocardial function by analysis of wall thickening on cine images and strain analysis of tissue tagged images.• Strain analysis is superior to wall thickening in differentiating between different degrees of myocardial injury after acute myocardial infarction.• Peak circumferential strain is the most accurate marker of regional function.
Highlights
Emergency percutaneous coronary intervention (PCI) in acute myocardial infarction (MI) restores epicardial coronary blood flow, microvascular perfusion is not restored in up to 40% of patients because of microvascular injury [1]
Cardiovascular magnetic resonance imaging (CMR) can quantify regional myocardial function by analysis of wall thickening on cine images and strain analysis of tissue tagged images
Infarct size was more than two-fold larger if microvascular obstruction (MVO) was present (25 ± 9 % vs. 11 ± 8 %; p < 0.001) and the amount of MVO correlated with infarct size (r = 0.65; p < 0.001)
Summary
Emergency percutaneous coronary intervention (PCI) in acute myocardial infarction (MI) restores epicardial coronary blood flow, microvascular perfusion is not restored in up to 40% of patients because of microvascular injury [1]. Regional function can be assessed with CMR by analysis of wall thickening on steady-state free precession (SSFP) cine imaging [9]. Regional function is quantified by analysis of strain using myocardial tissue tagging. In the pre-LGE era, myocardial strain was reported to be superior to wall thickening in differentiating dysfunctional from functional myocardium [10]. The accuracy of strain analysis in discriminating between different degrees of myocardial injury, as determined using LGE, is still unknown. The aim of the present study was to compare the diagnostic performances of strain and wall thickening analysis in discriminating among three types of tissue: non-infarcted myocardium, infarcted myocardium without MVO and infarcted myocardium with MVO
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