Key result
Circumferential strain demonstrated the highest diagnostic accuracy in differentiating viable from non-viable myocardium among segmental parameters, with an AUC of 0.827.
Why the study?
The study aimed to assess whether non-contrast myocardial strain, T1, and T2 mapping can evaluate myocardial damage severity and discriminate viable from non-viable myocardium in subacute myocardial infarction.
Can myocardial strain, T1, and T2 mapping accurately discriminate viable from non-viable myocardium compared to late gadolinium enhancement in the subacute phase of myocardial infarction?
Cross-Sectional (n=51)
Blinded analysts
No
Can myocardial strain, T1, and T2 mapping accurately discriminate viable from non-viable myocardium compared to late gadolinium enhancement in the subacute phase of myocardial infarction?
Effect estimate: AUC 0.827 (95% CI 0.792-0.861)
p-value: p=<0.001
Myocardial strain, particularly circumferential strain, along with T1 and T2 mapping, shows promise as a non-contrast alternative to late gadolinium enhancement for assessing myocardial viability in subacute myocardial infarction.
May support non-contrast CMR viability assessment post-MI; leaves open larger validation trials before clinical use.
This study aims to assess the potential of myocardial strain, T1 and T2 mapping in evaluating myocardial damage severity, thereby discriminating viable from non-viable myocardium without utilizing contrast agents in the subacute phase of myocardial infarction. Fourty three patients (mean age 56.05±10 years, 86% male) and eight sex and age-matched healthy volunteers underwent 1.5 T CMR with viability protocol. The global values were compared between patients and controls, and segmental values were compared in viable and non-viable myocardium determined by late gadolinium enhancement (LGE) as gold standard for viability assessment. The mean value of global myocardial strain parameters, including global longitudinal strain (GLS), global radial strain (GRS), and global circumferential strain (GCS) in the patient's group, was significantly lower than controls. In contrast, the mean value of Global T1 and T2 in the patient's group was significantly higher than in controls. Global infarcted zone size (IZS) and grey zone size (GZS) positively correlate with the T1 and T2 mapping and negatively with strain mapping global values. A comparison of segmental parameters based on viability demonstrated a significant decrease in the values of strains and a significant increase in the T1 and T2 mapping values in non-viable segments. ROC analysis demonstrated that circumferential strain (AUC 0.827, p<0.001, 95%CI 0.792–0.861) had the highest diagnostic accuracy in differentiating viable and non-viable myocardium among segmental parameters. A cut-off of a circumferential strain of -8.809 differentiated viable from non-viable segments with 81% sensitivity and 71% specificity. The good accuracy in predicting myocardial viability, the significant mean difference between viable and non-viable parametric values, and the significant correlation between global values and enhanced and grey zone size, holds promises for using strain, T1, and T2 mapping for viability assessment without gadolinium contrast agents.
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Mohammadzadeh et al. (2023) conducted a cross-sectional in Subacute myocardial infarction (n=51). Native T1, T2 mapping and strain analysis vs. Late gadolinium enhancement (LGE) was evaluated on Diagnostic accuracy in differentiating viable and non-viable myocardium (AUC 0.827, 95% CI 0.792-0.861, p=<0.001). Circumferential strain demonstrated the highest diagnostic accuracy in differentiating viable from non-viable myocardium among segmental parameters, with an AUC of 0.827.
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