Key result
Combining GLS and layer-specific strain via fSENC CMR identifies ACS, potentially cutting unnecessary angiographies ~35%.
Why the study?
Only a subset of early myocardial injury detected by high-sensitivity troponin reflects coronary plaque rupture requiring invasive therapy, and layer-specific strain using fast strain-encoded CMR may help identify ischemic causes.
Does layer-specific CMR strain analysis using fSENC accurately identify ischemic myocardial injury in patients with suspected acute coronary syndrome?
Observational (n=108)
Single-blind
No
Does layer-specific CMR strain analysis using fSENC accurately identify ischemic myocardial injury in patients with suspected acute coronary syndrome?
Effect estimate: AUC 93.2% (95% CI 87.9-98.4)
p-value: p=<0.001
Layer-specific CMR strain analysis using fSENC provides high diagnostic accuracy for identifying acute coronary syndrome in patients with chest pain and low-to-intermediate MACE probability, potentially reducing unnecessary invasive angiographies.
BACKGROUND: High-sensitivity troponin assays detect myocardial injury early, but only a subset reflects coronary plaque rupture requiring invasive therapy. Cardiovascular magnetic resonance (CMR) is the non-invasive reference standard for tissue characterization and functional assessment. Fast Strain-ENCoded imaging (fSENC) enables rapid strain analysis, and layer-specific strain may help identify ischemic causes. METHODS: In this prospective, single-centre observational study, patients presenting with chest pain and low-to-intermediate pretest probability for major adverse cardiac events (MACE) underwent rapid CMR prior to further therapy. Based on final clinical diagnosis, patients were classified as Healthy, acute coronary syndrome (ACS), or other cardiac abnormality (OCA). Global longitudinal strain (GLS) and the difference between endocardial and epicardial GLS (GLS-Dif) were quantified using fSENC. Follow-up assessed death and MACE. RESULTS: A total of 108 patients (50 female; age 57.5 ± 17.4 years) were included. Total scanning time was 14 ± 3 min. GLS was significantly reduced in ACS (- 17.1%) and OCA (- 15.8%) compared with Healthy patients (- 20.1%; both p < 0.001), predicting any cardiac abnormality with an AUC of 86.5%. GLS-Dif was negative in ACS (- 0.6%) and significantly lower than in Healthy patients (1.5%) and OCA (0.95%), predicting ACS with an AUC of 91.3%. Combining GLS and GLS-Dif yielded excellent discrimination for cardiac abnormality (AUC 93.0%) and ACS (AUC 93.2%; sensitivity 100%; specificity 71.4%) and would have potentially reduced 35.3% of performed invasive coronary angiographies. Over a median follow-up > 5 years, death and MACE rates were low and unrelated to strain parameters. CONCLUSIONS: Layer-specific CMR strain analysis using fSENC reliably identifies ischemic myocardial injury in suspected ACS, supporting clinical decision-making and potentially reducing unnecessary invasive procedures.
No takes yet. Share an insight, caveat, or question.
Weberling et al. (2026) conducted an observational in Suspected acute coronary syndrome (n=108). Fast Strain-ENCoded (fSENC) cardiovascular magnetic resonance (GLS and GLS-Dif) vs. Standard clinical work-up was evaluated on Prediction of acute coronary syndrome using combined fSENC GLS and GLS difference (AUC 93.2%, 95% CI 87.9-98.4, p=<0.001). Combining global longitudinal strain and layer-specific strain difference using fast strain-encoded CMR accurately identified acute coronary syndrome with an AUC of 93.2%, potentially reducing unnecessary invasive coronary angiographies by 35.3%.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: