Segmental strain for scar detection in acute myocardial infarcts and in follow-up exams using non-contrast CMR cine sequences

Fig. 1. a 48-year old patient 2 days after infarction of the anteroseptal wall. Left column: LGE in segment 8, 13, 14 (red arrows), concomitant edema extends additionally into segments 2, 7, 16 (white arrows). Right column: Endo- and epicardially contoured basal, midventricular and apical cine short axis slices prepared for circumferential strain calculations with polar plot strain map. Infarcted segments display reduced SPCS values in the strain map. b 48-year old patient 35 days after infarction of the anteroseptal wall. Same patients as in a. Left column: LGE in segment 8, 13, 14 (red arrows), no concomitant edema; right column: Endo- and epicardially contoured basal, midventricular and apical cine short axis slices prepared for circumferential strain calculations with polar plot strain map. Infarcted segments display reduced SPCS values in the strain map

Fig. 2. Global strain values in patients and healthy controls. While GPCS, GPLS and GPRS values were very similar comparing both imaging time points, they were significantly impaired compared to healthy controls. GPCS global peak circumferential strain, GPLS global peak longitudinal strain, GPRS global peak radial strain

Fig. 3. Segmental strain values for infarcted segments and remote myocardium in acute and follow-up CMR. Significantly different values between infarcted and remote myocardium can be detected in SPCS for both imaging time points as well as in SPRS in the follow-up exams. SPCS segmental peak circumferential strain, SPLS segmental peak longitudinal strain, SPRS segmental peak radial strain

Fig. 4. Localization of infarcted segments showed in segmental circumferential strain calculations. Segmental strain calculations showed significantly more infarcted segments than visual assessment of wall motion abnormalities in cine images and this was significant in both imaging time points. In follow-up exams more infarcted segments were found in visual assessment of wall motion compared to acute infarcts (52% vs. 44.4%). LGE late gadolinium enhancement, SPCS segmental peak circumferential strain, VWMA visual wall motion assessment

Fig. 5. ROC curves for distinguishing infarcted and remote myocardium based on segmental strain parameters. Below a SPCS value of − 5.9% (sensitivity of 86.2%, specificity of 83.5%, AUC 0.89 [95% CI 0.878–0.923, p < 0.05]) segments are considered infarcted. The cut-off value for SPRS was 20.2% (sensitivity of 77.5%, specificity of 77.9%, AUC 0.78 [95% CI 0.718–0.814, p < 0.05]) and − 6.6% for SPLS (sensitivity of 60.4%, specificity of 72.9%, AUC 0.66 [95% CI 950.598–0.715, p < 0.05]). Infarcted segments in LGE were considered gold standard. LGE late gadolinium enhancement, ROC receiver operating characteristic, SPCS/SPRS/SPLS segmental peak circumferential/radial/longitudinal strain