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CLINICAL RESEARCH: CARDIAC IMAGING

Myocardial Deformation Imaging Based on Ultrasonic Pixel Tracking to Identify Reversible Myocardial Dysfunction

Michael Becker, MD^_*, Alexandra Lenzen, MD^_*, Christina Ocklenburg, MSc, Katharina Stempel^_*, Harald Kühl, MD^_*, Miria Neizel, MD^_*, Markus Katoh, MD, Rafael Kramann^_*, Joachim Wildberger, MD, Malte Kelm, MD^_* and Rainer Hoffmann, MD^_*,_*

^_* Department of Cardiology, University Hospital RWTH Aachen, Aachen, Germany
Department of Medical Statistics, University Hospital RWTH Aachen, Aachen, Germany
Department of Radiology, University Hospital RWTH Aachen, Aachen, Germany.

Manuscript received September 13, 2007; accepted October 12, 2007.

^_* Reprint requests and correspondence: Dr. Rainer Hoffmann, Medical Clinic I, University RWTH Aachen, Pauwelsstraße 30, 52057 Aachen, Germany. (Email: RHoffmann{at}UKAACHEN.de).

Objectives: This study evaluated the predictive value of myocardial deformation imaging for improvement in cardiac function after revascularization therapy in comparison with contrast-enhanced cardiac magnetic resonance imaging (ceMRI).

Background: Myocardial deformation imaging allows analysis of myocardial viability in ischemic left ventricular dysfunction.

Methods: In 53 patients with ischemic left ventricular dysfunction, myocardial viability was assessed using pixel-tracking–derived myocardial deformation imaging and ceMRI to predict recovery of function at 9 ± 2 months follow-up. For each left ventricular segment in a 16-segment model, peak systolic radial strain was determined from parasternal 2-dimensional echocardiographic views using an automatic frame-by-frame tracking system of natural acoustic echocardiographic markers (EchoPAC, GE Ultrasound, Horton, Norway), and the relative extent of hyperenhancement using ceMRI.

Results: Of 463 segments with abnormal baseline function, 227 showed regional recovery. Compared with segments showing functional improvement, those that failed to recover had lower peak radial strain (15.2 ± 7.5% vs. 22.6 ± 6.3%; p < 0.001) and a greater extent of hyperenhancement (56 ± 29% vs. 14 ± 17%; p < 0.001). Using a cutoff of 17.2% for peak systolic radial strain, functional recovery could be predicted with high accuracy (sensitivity 70.2%, specificity 85.1%, area under the curve 0.859, 95% confidence interval 0.825 to 0.893). The predictive value was similar to that of hyperenhancement by ceMRI (sensitivity 71.6%, specificity 92.1%, area under the curve 0.874, 95% confidence interval 0.840 to 0.901, at a cutoff of 43% hyperenhancement).

Conclusions: Myocardial deformation imaging based on frame-to-frame tracking of acoustic markers in 2-dimensional echocardiographic images is a powerful novel modality to identify reversible myocardial dysfunction (The Use of Myocardial Deformation Imaging; NCT00476320 [ClinicalTrials.gov] ).

Abbreviations and Acronyms   AUC = area under the curve   ceMRI = contrast-enhanced cardiac magnetic resonance imaging   CI = confidence interval   LV = left ventricle/ventricular   ROC = receiver-operating characteristic