Key result
LV long-axis strain and fast-SENC comparably identify myocardial dysfunction, outperforming feature tracking.
Why the study?
Left-ventricular long axis strain (LVLAS) may allow for rapid and simple measurement of myocardial deformation, but its diagnostic performance compared to fSENC and FT needed evaluation.
Does LVLAS or fSENC provide better diagnostic performance than FT for identifying cardiac pathology in patients presenting with chest pain?
Cross-Sectional (n=40)
double-blinded
randomized
No
Does LVLAS or fSENC provide better diagnostic performance than FT for identifying cardiac pathology in patients presenting with chest pain?
Absolute Event Rate: 0.771% vs 0.882%
fSENC and LVLAS are superior to feature tracking for the rapid identification of myocardial dysfunction in patients presenting with chest pain.
May support LVLAS or fSENC over feature tracking for dysfunction detection in chest pain; hypothesis-generating, requires prospective validation.
BACKGROUND: Myocardial strain imaging has gained importance in cardiac magnetic resonance (CMR) imaging in recent years as an even more sensitive marker of early left ventricular dysfunction than left-ventricular ejection fraction (LVEF). fSENC (fast strain encoded imaging) and FT (feature tracking) both allow for reproducible assessment of myocardial strain. However, left-ventricular long axis strain (LVLAS) might enable an equally sensitive measurement of myocardial deformation as global longitudinal or circumferential strain in a more rapid and simple fashion. METHODS: In this study we compared the diagnostic performance of fSENC, FT and LVLAS for identification of cardiac pathology (ACS, cardiac-non-ACS) in patients presenting with chest pain (initial hscTnT 5-52 ng/l). Patients were prospectively recruited from the chest pain unit in Heidelberg. The CMR scan was performed within 1 h after patient presentation. Analysis of LVLAS was compared to the GLS and GCS as measured by fSENC and FT. RESULTS: In total 40 patients were recruited (ACS n = 6, cardiac-non-ACS n = 6, non-cardiac n = 28). LVLAS was comparable to fSENC for differentiation between healthy myocardium and myocardial dysfunction (GLS-fSENC AUC: 0.882; GCS-fSENC AUC: 0.899; LVLAS AUC: 0.771; GLS-FT AUC: 0.740; GCS-FT: 0.688), while FT-derived strain did not allow for differentiation between ACS and non-cardiac patients. There was significant variability between the three techniques. Intra- and inter-observer variability (OV) was excellent for fSENC and FT, while for LVLAS the agreement was lower and levels of variability higher (intra-OV: Pearson > 0.7, ICC > 0.8; inter-OV: Pearson > 0.65, ICC > 0.8; CoV > 25%). CONCLUSIONS: While reproducibility was excellent for both FT and fSENC, it was only fSENC and the LVLAS which allowed for significant identification of myocardial dysfunction, even before LVEF, and therefore might be used as rapid supporting parameters for assessment of left-ventricular function.
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Siry et al. (2022) conducted a cross-sectional in Chest pain (n=40). Left-ventricular long axis strain (LVLAS) and fast-SENC vs. Feature tracking (FT) was evaluated on Diagnostic performance (AUC) for identification of cardiac pathology. Left-ventricular long axis strain (AUC 0.771) and fast-SENC (AUC 0.882) demonstrated comparable diagnostic performance for identifying myocardial dysfunction, outperforming feature tracking.
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