Cardiovascular Magnetic Resonance Tagging Research Articles

Cardiovascular magnetic resonance tagging imaging correlates with myocardial dysfunction and T2 mapping in idiopathic dilated cardiomyopathy.

To evaluate the details of myocardial dysfunction in dilated cardiomyopathy (DCM) patients using tagging images and the correlation of tagging imaging with tissue characteristics. Circumferential strain (Ecc) derived from tagging images was measured in 15 normal (NML) subjects (15 males; mean age 28.5 years) and 12 DCM patients (7 males; mean age 48.9 years). The following parameters were compared: (1) the magnitude of peak Ecc (Ecc*); (2) the coefficient of variation of the time of Ecc* (CVtime*), which indexes dyssynchrony; and (3) descriptive findings of time-Ecc curves. We also evaluated the correlations of Ecc* in DCM patients with ejection fraction (EF), myocardial T2 values, and late gadolinium enhancement (LGE). Mean Ecc*s in DCM patients and NML subjects were -12.7 and -23.5%, respectively (P < 0.0001). Mean CVtime*s were 15.2 and 4.5%, respectively (P = 0.0002). The findings of pre-systolic extension and systolic stretch in the septum were observed in 6 (50%) and 10 (83.3%) DCM patients and in none of the NML participants. Ecc* was correlated with EF (P < 0.0001, R2 = 0.90) and T2 values (P = 0.018, R2 = 0.44) but not with LGE (P = 0.072, R2 = 0.28). Tagging images revealed the reduction of myocardial function as well as dyssynchrony in DCM patients. Myocardial dysfunction occurred coincidently with myocardial inflammation.

A robust and accurate center-frequency estimation (RACE) algorithm for improving motion estimation performance of SinMod on tagged cardiac MR images without known tagging parameters

A robust and accurate center-frequency (CF) estimation (RACE) algorithm for improving the performance of the local sine-wave modeling (SinMod) method, which is a good motion estimation method for tagged cardiac magnetic resonance (MR) images, is proposed in this study. The RACE algorithm can automatically, effectively and efficiently produce a very appropriate CF estimate for the SinMod method, under the circumstance that the specified tagging parameters are unknown, on account of the following two key techniques: (1) the well-known mean-shift algorithm, which can provide accurate and rapid CF estimation; and (2) an original two-direction-combination strategy, which can further enhance the accuracy and robustness of CF estimation. Some other available CF estimation algorithms are brought out for comparison. Several validation approaches that can work on the real data without ground truths are specially designed. Experimental results on human body in vivo cardiac data demonstrate the significance of accurate CF estimation for SinMod, and validate the effectiveness of RACE in facilitating the motion estimation performance of SinMod.

119 Cardiovascular Magnetic Resonance Evaluation of Change in Myocardial Strain following Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR)

BackgroundTAVI is the treatment of choice for patients with severe symptomatic aortic stenosis (AS) who are at high surgical risk. AS results in changes in myocardial strain and twist. Myocardial...

Interstitial Fibrosis, Left Ventricular Remodeling, and Myocardial Mechanical Behavior in a Population-Based Multiethnic Cohort

Background— Tagged cardiac magnetic resonance provides detailed information on regional myocardial function and mechanical behavior. T1 mapping by cardiac magnetic resonance allows noninvasive quantification of myocardial extracellular expansion (ECE), which has been related to interstitial fibrosis in previous clinical and subclinical studies. We assessed sex-associated differences in the relation of ECE to left ventricular (LV) remodeling and myocardial systolic and diastolic deformation in a large community-based multiethnic population. Methods and Results— Midventricular midwall peak circumferential shortening and early diastolic strain rate and LV torsion and torsional recoil rate were determined using cardiac magnetic resonance tagging. Midventricular short-axis T1 maps were acquired in the same examination pre- and postcontrast injection using Modified Look-Locker Inversion-Recovery sequence. Multivariable linear regression (estimated regression coefficient, B ) was used to adjust for risk factors and subclinical disease measures. Of 1230 participants, 114 had a visible myocardial scar by late gadolinium enhancement. Participants without a visible myocardial scar (n=1116) had no history of previous clinical events. In the latter group, multivariable linear regression demonstrated that lower postcontrast T1 times, reflecting greater ECE, were associated with lower circumferential shortening ( B =−0.1; P =0.0001), lower LV end-diastolic volume index ( B =0.6; P =0.0001), and lower LV end-diastolic mass index ( B =0.4; P =0.0001). In addition, lower postcontrast T1 times were associated with lower early diastolic strain rate ( B =0.01; P =0.03) in women only and lower LV torsion ( B =0.005; P =0.03) and lower LV ejection fraction (B=0.2, P =0.01) in men only. Conclusions— Greater ECE is associated with reduced LV end-diastolic volume index and LV end-diastolic mass index in a large multiethnic population without history of previous cardiovascular events. In addition, greater ECE is associated with reduced circumferential shortening, lower early diastolic strain rate, and a preserved ejection fraction in women, whereas in men, greater ECE is associated with greater LV dysfunction manifested as reduced circumferential shortening, reduced LV torsion, and reduced ejection fraction.

Prognostic value of myocardial strain analysis with cardiac magnetic resonance in patients with dilated cardiomyopathy

Background Myocardial deformation analysis is an important task in the evaluation of heart failure. We and other previously showed that myocardial strain is a more sensitive marker for the prediction of cardiac events compared with leftventricular ejection-fraction (LV-EF). The current gold standard technique to quantify myocardial deformation is CMR tagging. However, additional pulse sequences and specialized software are necessary with tagging, so that alternative ways for the estimation of strain in CMR using conventional steady-state-free-precession (SSFP) cine images would be preferable. In this regards, feature tracking is a novel tool, which can be run on conventional cine images and can help estimating myocardial strain and strain rate without the need of specialized tagging sequences. The aim was to investigate the prognostic impact of myocardial strain using feature tracking cardiac magnetic resonance in patients with dilated cardiomyopathy. Methods Patients with dilated cardiomyopathy (n = 210) were examined in a 1.5T CMR-scanner. SSFP cine sequences of the three short and the three long axis views were analyzed using a prototype feature tracking software algorithm (2D CPA MR © ,T omTec Imaging Systems GmbH). Circumferential, longitudinal and radial strains were quantitatively assessed. Patient follow-up evaluation included the composite endpoint for the occurrence of cardiac death, heart transplantation and aborted sudden cardiac death. Patients were divided in subgroups by the appearance and absence of the composite endpoint, respectively, by left-ventricular ejection-fraction (LVEF≤35% and EF > 35%) and by the presence or absence of late gadolinium enhancement (LGE). Results The predefined primary endpoint, a combined endpoint of cardiac death, heart transplantation and aborted sudden cardiac death occurred in 26 subjects during the median follow-up period of 5.3 years. Global LV longitudinal strain < -12.5% was a significant predictor of survival. Using multivariable analysis global longitudinal strain exhibited an independent prognostic value for the composite endpoint surpassing the value of NYHA functional class, NT-proBNP, LV-EF, global LV radial and circumferential strain as well as LGE (HR = 1.23, p < 0.05). Reduced global longitudinal strain (≥-12.5%) was strongly predictive for worse outcomes even in patients with non-severely impaired LV-EF (≥35%; HR = 0.025, c 2 = 37.9, p < 0.001) and in those without LGE (HR = 0.12, c 2 = 12.7, p < 0.001). Global longitudinal strain < -12.5% on the other hand, predicted favorable outcome even in patients with severely impaired EF < 35% (HR = 0.21, c 2 = 7.9, p < 0.01) and in those with LGE (HR = 0.07, c 2 = 21.2, p < 0.001).

CMR evaluation of change in myocardial strain following transcatheter aortic valve implantation

Background Transcatheter Aortic Valve Implantation (TAVI) is the treatment of choice for patients with severe symptomatic aortic stenosis (AS) who are at high surgical risk. AS results in changes in myocardial strain and twist. Myocardial strain, strain rate and twist can be measured with myocardial tagging CMR. It is not known how TAVI affects LV diastolic and systolic function as measured by CMR tagging.

Non-uniform polar tagging

Background CMR tagging in polar patterns is desirable because of its close compatibility to the annular geometry and motion of the left ventricle in short axis view. This circular symmetry does not exist in some pathological cases neither in the normal long axis view. An oval-shaped pattern is more suitable for assessment of the deformation in these conditions. Herein, we present the non-uniform polar tagging method and also present the preliminary images [1].

Cardiac motion and strain detection using 4D CT images: comparison with tagged MRI, and echocardiography

Ischemic heart disease is a leading cause of death in the modern world. Coronary obstruction is the basis for ischemic heart disease and leads to decreased cardiac supply and decreased contractility of the myocardium. Recently, high quality 4D computed tomography (CT) has become available for cardiac imaging and provides the clinician with high quality anatomical images. In this article, a new method is proposed to detect 3D motion and strain from 4D cardiac CT images by constraining intensity constancy, myocardial volume changes and motion smoothness assumptions. The proposed method is validated by using manual tracking of the cardiac CT landmarks. The average error for the manual tracking, by an expert, was 2.9 ± 0.9 mm. As an additional validation, the cardiac CT strain values were compared to the cardiac tagged magnetic resonance imaging (MRI) and 2D B-mode echocardiography strain values of the same patients. The correlation ratio was significantly high for CT and tagged MRI radial strain values (r = 0.76, 95% confidence interval, P < 0.001). The correlation ratio was meaningful for CT and echocardiography radial strain values as well (r = 0.67, 95% confidence interval, P < 0.001). The correlation ratio for CT and tagged MRI circumferential strain values was acceptable (r = 0.73, 95% confidence interval, P < 0.001), while the correlation ratio for CT and echocardiography circumferential strain values was good as well (r = 0.61, 95% confidence interval, P < 0.001). In general, motion and strain values computed from cardiac CT images agree with motion and strain values computed from tagged MRI and echocardiography images.

1041Early changes in regional heart function in Tgalphaq*44 murine model of dilated cardiomyopathy as assessed by CMR Tagging

1041Early changes in regional heart function in Tgalphaq*44 murine model of dilated cardiomyopathy as assessed by CMR Tagging

Myocardial Motion Estimation From Medical Images Using the Monogenic Signal

We present a method for the analysis of heart motion from medical images. The algorithm exploits monogenic signal theory, recently introduced as an N-dimensional generalization of the analytic signal. The displacement is computed locally by assuming the conservation of the monogenic phase over time. A local affine displacement model is considered to account for typical heart motions as contraction/expansion and shear. A coarse-to-fine B-spline scheme allows a robust and effective computation of the model's parameters, and a pyramidal refinement scheme helps to handle large motions. Robustness against noise is increased by replacing the standard point-wise computation of the monogenic orientation with a robust least-squares orientation estimate. Given its general formulation, the algorithm is well suited for images from different modalities, in particular for those cases where time variant changes of local intensity invalidate the standard brightness constancy assumption. This paper evaluates the method's feasibility on two emblematic cases: cardiac tagged magnetic resonance and cardiac ultrasound. In order to quantify the performance of the proposed method, we made use of realistic synthetic sequences from both modalities for which the benchmark motion is known. A comparison is presented with state-of-the-art methods for cardiac motion analysis. On the data considered, these conventional approaches are outperformed by the proposed algorithm. A recent global optical-flow estimation algorithm based on the monogenic curvature tensor is also considered in the comparison. With respect to the latter, the proposed framework provides, along with higher accuracy, superior robustness to noise and a considerably shorter computation time.

Inter-study reproducibility of cardiovascular magnetic resonance tagging.

BackgroundThe aim of this study is to determine the test-retest reliability of the measurement of regional myocardial function by cardiovascular magnetic resonance (CMR) tagging using spatial modulation of magnetization.MethodsTwenty-five participants underwent CMR tagging twice over 12 ± 7 days. To assess the role of slice orientation on strain measurement, two healthy volunteers had a first exam, followed by image acquisition repeated with slices rotated ±15 degrees out of true short axis, followed by a second exam in the true short axis plane. To assess the role of slice location, two healthy volunteers had whole heart tagging. The harmonic phase (HARP) method was used to analyze the tagged images. Peak midwall circumferential strain (Ecc), radial strain (Err), Lambda 1, Lambda 2, and Angle α were determined in basal, mid and apical slices. LV torsion, systolic and early diastolic circumferential strain and torsion rates were also determined.ResultsLV Ecc and torsion had excellent intra-, interobserver, and inter-study intra-class correlation coefficients (ICC range, 0.7 to 0.9). Err, Lambda 1, Lambda 2 and angle had excellent intra- and interobserver ICC than inter-study ICC. Angle had least inter-study reproducibility. Torsion rates had superior intra-, interobserver, and inter-study reproducibility to strain rates. The measurements of LV Ecc were comparable in all three slices with different short axis orientations (standard deviation of mean Ecc was 0.09, 0.18 and 0.16 at basal, mid and apical slices, respectively). The mean difference in LV Ecc between slices was more pronounced in most of the basal slices compared to the rest of the heart.ConclusionsIntraobserver and interobserver reproducibility of all strain and torsion parameters was excellent. Inter-study reproducibility of CMR tagging by SPAMM varied between different parameters as described in the results above and was superior for Ecc and LV torsion. The variation in LV Ecc measurement due to altered slice orientation is negligible compared to the variation due to slice location.Trial registrationThis trial is registered as NCT00005487 at National Heart, Lung and Blood institute.

Feature tracking cardiac magnetic resonance imaging for the evaluation of myocardial strain in patients with dilated cardiomyopathy and in healthy controls

Background In clinical routine, quantification of myocardial strain using CMR tagging is currently the gold standard. Additional pulse sequences for the generation of tagged images and specialized software for the quantification of myocardial strain is necessary, so that alternative ways using conventional steady-state-free-precession (SSFP) sequence images would be preferable. This advantage may be ensured by feature tracking imaging algorithm, a novel method of two-dimensional deformation analysis. To quantify myocardial deformation with two-dimensional feature tracking cardiac magnetic resonance (CMR) in patients with heart failure due to nonischemic cardiomyopathy and in healthy controls. Methods Eighty-eight patients with dilated cardiomyopathy and thirty healthy subjects were examined in a 1.5T CMRscanner. SSFP cine sequences of the four chamber view and mid-ventricular short axis view were analyzed using feature tracking imaging software (2D CPA MR©, TomTec Imaging Systems GmbH). Generated parameters of the myocardial quantification were circumferential and longitudinal strain, respectively. Furthermore, patients were divided in subgroups classified by left-ventricular ejection-fraction LV-EF≤35% and EF>35% and in patients with the presence or absence of late-gadolinium enhancement (LGE), respectively. Results In patients with dilated cardiomyopathy, close correlation were observed for the LV-EF with circumferential strain (r^2=0.8, p 35% and with LV-EF ≤35% (p<0.0001). In addition, patients with LGE yielded significant lower circumferential and longitudinal strain values, compared to those without LGE (p<0.0001 and p=0.02, respectively). Conclusions Feature tracking imaging determines global myocardial function in patients with dilated cardiomyopathy and provides further insight into the underlying remodeling processes. Further investigation is necessary to analyze the impact of this new method on clinical outcome. Funding none

In vivo validation of an ultra-high field, high temporal resolution myocardial tagging technique for assessment of diastolic function in mice

Background Heart failure with preserved ejection fraction accounts for approximately half of all heart failure cases and is associated with similar morbidity and mortality. Although abnormalities of diastolic function are felt to play an important role, no specific treatments have been identified for this common condition, primarily because of poor understanding of its pathophysiology. Despite development of several murine models of this disease, accurate non-invasive assessment of diastolic function has been challenging. Echocardiographic measurements have been limited by small heart sizes, rapid ventricular rates and high inter-observer variability. The aim of this study was to assess the ability of ultra-high field, high temporal resolution CMR tagging to assess diastolic function in mice, compared to the gold-standard technique of invasive pressure-volume loop analysis.

Age, Sex, and Hypertension-Related Remodeling Influences Left Ventricular Torsion Assessed by Tagged Cardiac Magnetic Resonance in Asymptomatic Individuals

Background— The aim of the present study was to evaluate how torsion is influenced by left ventricular (LV) remodeling associated with age, sex, and hypertension in a large community-based population. Methods and Results— Myocardial shortening and torsion were assessed by tagged cardiac magnetic resonance in 1478 participants without clinically apparent cardiovascular disease in the Multi-Ethnic Study of Atherosclerosis (MESA). Torsion was defined as the difference between apical and basal rotation divided by slice distance. In multivariable linear regression models, older age was associated with lower stroke volume (−3.6 mL per decade; P &lt;0.001) and higher LV mass-to-volume ratio (0.03 g/mL per decade; P &lt;0.001), along with lower circumferential shortening (−0.17% per decade; P &lt;0.05). Torsion, however, was greater at older ages (0.14° per decade; P &lt;0.001) and in women (0.37°/cm versus men; P &lt;0.001). Hypertensive participants had higher LV mass and LV mass-to-volume ratio (15.5 g and 0.07 g/mL, respectively; P &lt;0.001 for both). Circumferential shortening was lower in hypertensive (−0.42%; P &lt;0.01), whereas torsion was higher after adjustment for age and sex (0.17°/cm; P &lt;0.05). Conclusions— Older age is associated with lower LV volumes and greater relative wall thickness and is accompanied by lower circumferential myocardial shortening, whereas torsion is greater with older age. Hypertensive individuals have greater LV volumes and relative wall thickness and lower circumferential shortening. Torsion, however, is greater in hypertension independently of age and sex. Torsion may therefore represent a compensatory mechanism to maintain an adequate stroke volume and cardiac output in the face of the progressively reduced LV volumes and myocardial shortening associated with hypertension and aging.

Construction of a two-parameter empirical model of left ventricle wall motion using cardiac tagged magnetic resonance imaging data

BackgroundA one-parameter model was previously proposed to characterize the short axis motion of the LV wall at the mid-ventricle level. The single parameter of this model was associated with the radial contraction of myocardium, but more comprehensive model was needed to account for the rotation at the apex and base levels. The current study developed such model and demonstrated its merits and limitations with examples.Materials and methodsThe hearts of five healthy individuals were visualized using cardiac tagged magnetic resonance imaging (tMRI) covering the contraction and relaxation phases. Based on the characteristics of the overall dynamics of the LV wall, its motion was represented by a combination of two components - radial and rotational. Each component was represented by a transformation matrix with a time-dependent variable α or β.Image preprocessing step and model fitting algorithm were described and applied to estimate the temporal profiles of α and β within a cardiac cycle at the apex, mid-ventricle and base levels. During this process, the tagged lines of the acquired images served as landmark reference for comparing against the model prediction of the motion. Qualitative and quantitative analyses were performed for testing the performance of the model and thus its validation.ResultsThe α and β estimates exhibited similarities in values and temporal trends once they were scaled by the radius of the epicardium (repi)and plotted against the time scaled by the period of the cardiac cycle (Tcardiac) of each heart measured during the data acquisition. α/repi peaked at about Δt/Tcardiac=0.4 and with values 0.34, 0.4 and 0.3 for the apex, mid-ventricle and base level, respectively. β/repi similarly maximized in amplitude at about Δt/Tcardiac=0.4, but read 0.2 for the apex and - 0.08 for the base level. The difference indicated that the apex twisted more than the base.ConclusionIt is feasible to empirically model the spatial and temporal evolution of the LV wall motion using a two-parameter formulation in conjunction with tMRI-based visualization of the LV wall in the transverse planes of the apex, mid-ventricle and base. In healthy hearts, the analytical model will potentially allow deriving biomechanical entities, such as strain, strain rate or torsion, which are typically used as diagnostic, prognostic or predictive markers of cardiovascular diseases including diabetes.

Potential of Cardiac MRI for Predicting the Risk of Heart Failure

Cardiac magnetic resonance (CMR) is a noble method to evaluate cardiac function and myocardial perfusion. Quantitative analysis of myocardial perfusion MRI can provide noninvasive assessment of myocardial perfusion reserve (MPR). CMR tagging has been established as a technique for quantification of local intramyocardial motion measures, e.g. strain and strain rate using displacement encoding with stimulated echoes (DENSE).

High-sensitivity C-reactive protein as an independent predictor of progressive myocardial functional deterioration: The multiethnic study of atherosclerosis

Systemic inflammation has been linked to the development of heart failure in population studies including Multi-Ethnic Study of Atherosclerosis (MESA), but little evidence exists regarding potential mechanism of this relationship. In this study, we used longitudinal magnetic resonance imaging follow-up analysis to examine whether C-reactive protein (CRP) levels relate to progressive myocardial functional deterioration as a potential mechanism of incident heart failure. Regional myocardial functional data from MESA participants who had baseline CRP measurement and also underwent tagged cardiac magnetic resonance imaging both at baseline and at 5-year follow-up were analyzed. Left ventricular midwall and midslice peak circumferential strain (Ecc), of which a more negative value denotes stronger regional myocardial function, was measured. Circumferential strain change was calculated as the difference between baseline and follow-up Ecc. During the follow-up period, participants (n = 785) with elevated CRP experienced a decrease in strain, independent of age, gender, and ethnicity (B = 0.081, ∆Ecc change per 1 mg/L CRP change, 95% CI 0.036-0.126, P < .001, model 1) and, additionally, beyond systolic blood pressure, heart rate, diabetes, smoking status, body mass index, current medication, and glomerular filtration rate (B = 0.099, 0.052-0.145, P < .001, model 2). The relationship remained statistically significant after further adjustment for left ventricular mass, coronary calcium score, and interim clinical coronary events (B = 0.098, 0.049-0.147, P < .001, model 3). Higher CRP levels are related to progressive myocardial functional deterioration independent of subclinical atherosclerosis and clinical coronary events in asymptomatic individuals without previous history of heart disease.

Polar HARP for the polar CMR tagging

Background The polar coordinate system adapts best to the morphology of the heart. The recently developed sequences that allow the CMR Tagging in the circular and radial directions facilitate the calculation and presentation of the myocardium mechanics. Development of the corresponding processing methods is required to further enhance the utilization of these sequences. Here we suggest a processing method based on the harmonic phase approach to obtain the high-resolution motion in polar coordinate system.

Does the amplatzer septal occluder device alter ventricular contraction pattern? A ventricular motion analysis by MR tagging

To assess by cardiovascular magnetic resonance (CMR) and CMR tagging if the Amplatzer Septal Occluder affects right ventricular (RV) and left ventricular (LV) motion pattern. Sixteen consecutive patients with significant atrial septal defect (ASD) and nine consecutive patients with persistent foramen ovale (PFO) as controls were studied before and a median of 14 days after defect closure by an Amplatzer occluder. By CMR end-diastolic (EDV) and end-systolic (ESV) RV and LV volumes were determined. Aortic and pulmonary artery flow was measured for assessment of left-to-right shunt (Qp/Qs). By CMR tagging circumferential strain and radial shortening, maximal rotation and torsion were measured, In ASD patients RV-EDV and RV-ESV decreased (P < 0.05). LV-EDV and LV-ESV increased after ASD closure (P < 0.005). Qp/Qs dropped from 1.8 to 1.0 (P < 0.001). PFO patients showed no ventricular volume change after PFO closure. In ASD patients circumferential strain and radial shortening and maximal rotation of the RV decreased by ASD closure (P < 0.01). In LV only maximal rotation at the base and apex decreased significantly (P < 0.05). Torsion remained constant. In PFO patients no tagging parameter changed after defect closure. The Amplatzer occluder itself does not change the ventricular contraction pattern. All volume and myocardial deformation changes were caused by ventricular loading shifts.

Subendocardial contractile impairment in chronic ischemic myocardium: assessment by strain analysis of 3T tagged CMR.

BackgroundThe purpose of this study was to quantify myocardial strain on the subendocardial and epicardial layers of the left ventricle (LV) using tagged cardiovascular magnetic resonance (CMR) and to investigate the transmural degree of contractile impairment in the chronic ischemic myocardium.Methods3T tagged CMR was performed at rest in 12 patients with severe coronary artery disease who had been scheduled for coronary artery bypass grafting. Circumferential strain (C-strain) at end-systole on subendocardial and epicardial layers was measured using the short-axis tagged images of the LV and available software (Intag; Osirix). The myocardial segment was divided into stenotic and non-stenotic segments by invasive coronary angiography, and ischemic and non-ischemic segments by stress myocardial perfusion scintigraphy. The difference in C-strain between the two groups was analyzed using the Mann-Whitney U-test. The diagnostic capability of C-strain was analyzed using receiver operating characteristics analysis.ResultsThe absolute subendocardial C-strain was significantly lower for stenotic (-7.5 ± 12.6%) than non-stenotic segment (-18.8 ± 10.2%, p < 0.0001). There was no difference in epicardial C-strain between the two groups. Use of cutoff thresholds for subendocardial C-strain differentiated stenotic segments from non-stenotic segments with a sensitivity of 77%, a specificity of 70%, and areas under the curve (AUC) of 0.76. The absolute subendocardial C-strain was significantly lower for ischemic (-6.7 ± 13.1%) than non-ischemic segments (-21.6 ± 7.0%, p < 0.0001). The absolute epicardial C-strain was also significantly lower for ischemic (-5.1 ± 7.8%) than non-ischemic segments (-9.6 ± 9.1%, p < 0.05). Use of cutoff thresholds for subendocardial C-strain differentiated ischemic segments from non-ischemic segments with sensitivities of 86%, specificities of 84%, and AUC of 0.86.ConclusionsAnalysis of tagged CMR can non-invasively demonstrate predominant impairment of subendocardial strain in the chronic ischemic myocardium at rest.