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Strain Rate Imaging Differentiates Transmural From Non-Transmural Myocardial Infarction

A Validation Study Using Delayed-Enhancement Magnetic Resonance Imaging

Yan Zhang, MB, PhD^_*, Anna K.Y. Chan, MRCP^_*, Cheuk-Man Yu, MD, FRCP^_*, Gabriel W.K. Yip, MD^_*, Jeffrey W.H. Fung, FRCP^_*, Wynnie W.M. Lam, FRCR, Nina M.C. So, FRCR, Mei Wang, MB, PhD^_*, Eugene B. Wu, MD, MRCP^_*, John T. Wong, MRCP^_* and John E. Sanderson, MD, FACC^_*,_*

^_* Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR
Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR

View larger version (84K): [in a new window]   Figure 1 (A) Strain rate profile of a normal subject and (B) a transmural infarct. (A) Shows peak systolic strain rate (SRs), early diastolic strain rate (SRe), and atrial strain rate (SRa) are uniform in basal, mid-, and apical segments in a normal septum. However, in (B) with a transmural basal inferior infarct basal SRs is markedly reduced oscillating around the zero line compared to the mid- and apical segments. (C) Shows the corresponding transmural infarct by contrast-enhanced magnetic resonance imaging.

View larger version (15K): [in a new window]   Figure 2 Mean ± 1 SD of strain rate peak systolic strain rate (SRs) and early diastolic strain rate (SRe) in different infarcted segments. *p < 0.05 vs. controls; **p < 0.01 vs. controls; p < 0.05 vs. non-transmural myocardial infarction (Nontrans-MI); p < 0.0005 vs. transmural MI (Trans-MI) or control. Subendo-MI = subendocardial MI.

View larger version (16K): [in a new window]   Figure 3 Scatter plot of strain rates peak systolic strain rate (SRs) of the infarct area and infarct size on contrast-enhanced magnetic resonance imaging (correlation coefficient = 0.63, p < 0.0005).

View larger version (23K): [in a new window]   Figure 4 Results of receiver-operating characteristic curve analysis. Peak systolic strain rate (SRs) distinguishes transmural (Trans-MI) from non-transmural (Nontrans-MI) or subendocardial (Subendo-MI) infarction with high sensitivity and specificity. Both SRs and early diastolic strain rate (SRe) can be used to detect an infarction from normal myocardium. AUC = area under the curve; ROC = receiver-operating characteristic.