Key result
Adding layer-specific fast strain-encoded CMR to standard care improves NSTEMI identification with ~96% AUC.
Why the study?
Acute myocardial injury has numerous differential diagnoses, and this study evaluated whether a layer-specific fast strain ENCoded CMR approach offered diagnostic and prognostic benefits.
Does layer-specific fast strain-encoded CMR improve the identification and discrimination of acute myocardial injury compared to standard care in emergency department patients?
Cohort (n=114)
Does layer-specific fast strain-encoded CMR improve the identification and discrimination of acute myocardial injury compared to standard care in emergency department patients?
Effect estimate: AUC 95.5%
p-value: p=0.03
Layer-specific fast strain-encoded CMR provides high diagnostic performance for identifying and differentiating acute myocardial injuries, significantly improving upon standard care.
May aid NSTEMI identification in ED observational data; leaves open need for RCTs before practice change.
Acute myocardial injury is a common diagnosis in the emergency department and differential diagnoses are numerous. Cardiac magnetic resonance (CMR) strain sequences, such as fast strain ENCoded (fSENC), are early predictors of myocardial function loss. This study assessed the potential diagnostic and prognostic benefits of a layer-specific approach. For this prospective study, patients in the emergency department fulfilling rule-in criteria for non-ST-elevation myocardial infarction (NSTEMI) received an ultra-fast fSENC CMR. Volunteers without cardiac diseases (controls) were recruited for comparison. Measurements were performed in a single heartbeat acquisition to measure global longitudinal strain (GLS) and segmental longitudinal strain and dysfunctional segments. The GLS was measured in two layers and a difference (GLSdifference = GLSepicardial – GLSendocardial) was calculated. The performance of those strain features was compared to standard care (physical examination, cardiac biomarkers, electrocardiogram). According to the final diagnosis after discharge, patients were divided into groups and followed up for 2 years. A total of 114 participants, including 50 controls, were included. The 64 patients (51 male) were divided into a NSTEMI (25), myocarditis (16), and other myocardial injury group (23). GLS served as a potent predictor of myocardial injury (area under the curve (AUC) 91.8%). The GLSdifference provided an excellent diagnostic performance to identify a NSTEMI (AUC 83.2%), further improved by including dysfunctional segments (AUC 87.5%, p = 0.01). An optimal test was achieved by adding fSENC to standard care (AUC 95.5%, sensitivity 96.0%, specificity 86.5%, p = 0.03). No death occurred in 2 years for patients with normal GLS and ≤5 dysfunctional segments, while three patients died that showed abnormal GLS or >5 dysfunctional segments. Layer-specific strain is a potential new marker with high diagnostic performance in the identification and differentiation of acute myocardial injuries.
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Weberling et al. (2024) conducted a cohort in Acute myocardial injury (n=114). Layer-specific fast strain-encoded (fSENC) cardiac magnetic resonance imaging vs. Standard care (physical examination, cardiac biomarkers, electrocardiogram) was evaluated on Diagnostic performance to identify NSTEMI (AUC 95.5%, p=0.03). Adding layer-specific fast strain-encoded cardiac magnetic resonance imaging to standard care significantly improved the identification of NSTEMI (AUC 95.5%, sensitivity 96.0%, specificity 86.5%, p=0.03).
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