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.
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Figure 1 ceMRI and Strain Imaging in Nontransmural Infarction
Contrast-enhanced magnetic resonance imaging (ceMRI) image (left), color-coded short-axis radial strain images at end-systole (middle), and radial strain tracings (right) for 1 cardiac cycle obtained from the same short-axis view in a patient with severe hypokinesia of the posterolateral wall. Contrast-enhanced magnetic resonance imaging indicates nontransmural infarction with less than 25% hyperenhancement. The 6 tracings for the 6 evaluated segments within the circumference demonstrate reduced peak negative systolic radial strain of the posterolateral wall. The segment demonstrated functional recovery after successful interventional revascularization of an occluded left circumflex artery.
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Figure 2 ceMRI and Strain Imaging in Transmural Infarction
Contrast-enhanced magnetic resonance imaging (ceMRI) image (left), color-coded short-axis radial strain images at end-systole (middle), and radial strain tracings (right) for 1 cardiac cycle obtained from the same short-axis view in a patient with akinesia of the septal wall. Contrast-enhanced magnetic resonance imaging indicates transmural infarction with more than 50% hyperenhancement. The tracings for the evaluated segments within the circumference demonstrate a low peak negative systolic radial strain of the septal wall. The segment demonstrated no functional recovery after coronary bypass surgery.
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Figure 3 Improvement in Segmental Function After Revascularization Related to Radial Systolic Strain and Hyperenhancement
Relation between peak systolic radial strain and likelihood of increased contractility after revascularization (left), and relation between transmural extent of hyperenhancement and likelihood of increased contractility after revascularization (right). Data are shown for all 463 dysfunctional segments before revascularization. The categories of hyperenhancement are given in the text. The categories of peak systolic radial strain were as follows: 1: >22.9%; 2: 22.9% to 17.2%; 3: 17.1% to 11.4%; 4: 11.3% to 5.6%; 5: <5.5% peak systolic radial strain.
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Figure 4 Correlation Between the Percentage of the LV That Was Dysfunctional but Defined to Be Viable Before Revascularization and the Change in EF After Revascularization
The left panel shows the analysis considering the peak systolic radial strain; the right panel shows the analysis considering the extent of hyperenhancement by contrast-enhanced magnetic resonance imaging for assessment of global left ventricular (LV) viability. EF = ejection fraction.
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Figure 5 ROC Curves
Receiver-operating characteristic (ROC) curves, including the area under the curve (AUC), for peak systolic radial strain and extent of myocardial hyperenhancement to predict segmental functional recovery (left) and global functional recovery (increase in ejection fraction >5%) (right) after revascularization.
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