Cardiovascular magnetic resonance myocardial feature tracking for quantitative viability assessment in ischemic cardiomyopathy☆
Introduction
Cardiovascular magnetic resonance (CMR) plays an increasingly important role in the diagnosis and assessment of coronary artery disease (CAD) as it has evolved into a comprehensive clinical tool with the unique capability of assessing myocardial function, viability and perfusion in one examination [1], [2]. Wall motion analysis is a central component of clinical routine. Due to its excellent image quality CMR is the gold standard for visualizing left ventricular (LV) endocardial wall motion at rest and also during low and high dose dobutamine challenges for the assessment of myocardial viability and ischemia [3], [4]. At present image analysis is mainly performed qualitatively with considerable operator dependency [5]. Quantitative analysis with myocardial tagging requires the acquisition of additional sequences and involves lengthy post processing [6]. Recently myocardial feature tracking (FT) has been introduced, which is an analog to echocardiographic speckle tracking [7]. This technique tracks tissue voxel motion in cine magnetic resonance (MR) images, which allows assessment of circumferential and radial myocardial strain. Therefore the acquisition of additional sequences is not required. Good agreement has been demonstrated between CMR-FT and harmonic phase imaging (HARP), a tagging based reference standard [8]. It has also been validated in normal volunteers during intermediate dose dobutamine stress [9].
The aim of the current study was therefore to determine the feasibility of CMR-FT for the quantitative detection of viable myocardium during low-dose dobutamine stress in a patient population with ischemic cardiomyopathy.
Section snippets
Methods
Consecutive patients (n = 15) referred for evaluation of ischemic cardiomyopathy were enrolled in this study and underwent CMR imaging on a 3 T clinical MR scanner (Achieva, Philips Medical Systems, Best, The Netherlands). The local ethics committee approved the study protocol. All patients gave written informed consent before the CMR examination.
Results
Dobutamine was tolerated in all 15 patients. The image quality was sufficient to perform strain analysis in 87% of all segments (208 of 240, Fig. 1). 32 segments were excluded due to insufficient quality due to breathing artifacts (n = 26) or inclusion of the outflow tract in the basal slice (n = 6) either at rest or any stress level. Participant demographics are shown in Table 1.
Discussion
The current study includes a population of patients with ischemic cardiomyopathy studied at rest and with low-dose dobutamine stress and demonstrates several important findings.
Firstly, CMR-FT can quantify changes in wall mechanics between rest and dobutamine stress in patients with ischemic cardiomyopathy. Secondly, there is an increase in strain in viable segments without LGE whereas there is no change in segments with transmural late gadolinium enhancement. Finally, there is considerable
Conclusions
CMR-FT allows derivation of strain mechanics from SSFP cine images at rest and during low dose dobutamine stress in patients with ischemic cardiomyopathy. Results correlate closely with the transmurality of myocardial scarring and visual analysis. If the current analysis algorithm can be further improved to reduce inter- and intra-observer variability CMR-FT could potentially result in simple and fast quantification of myocardial strain and may therefore aid assessment of contractile reserve
Competing interests
Eike Nagel received minor consultancy fees from Philips Healthcare and major grant support from Philips Healthcare and Bayer Schering Pharma. The other authors declare that they have no competing interests.
Acknowledgments
Andreas Schuster is a British Heart Foundation (BHF) Clinical Research Fellow (FS/10/029/28253). The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology.
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Grant support: Andreas Schuster and Eike Nagel were supported by the British Heart Foundation (BHF) (, ) and the Biomedical Research Centre (BRC-CTF 196). Eike Nagel received significant grant support from Bayer Schering Pharma and Philips Healthcare.