Role of feature tracking cardiac MRI in evaluation of ischemic cardiomyopathy

Background Ischemic cardiomyopathy (ICM) is characterized by profound left ventricular (LV) remodelling, impaired systolic function, and variable myocardial viability. Cardiac magnetic resonance feature tracking (CMR-FT) enables non-invasive quantification of myocardial deformation from standard cine sequences without dedicated tagging sequences. The present study aimed to evaluate the role of CMR-FT in the comprehensive assessment of myocardial function and viability in patients with ICM compared with healthy controls. Results Cases showed markedly elevated end-diastolic and end-systolic volumes with severely reduced ejection fraction (EF: 36.6 ± 16.9% vs. 64.1 ± 10.0%; p < 0.001). Stroke volume was preserved, reflecting Frank-Starling compensation. Wall motion abnormalities were concentrated in mid-cavity and apical territories. Apical segments demonstrated the highest transmural scar burden on LGE (apex 33.3%; apical inferior 35.3%). All three global strain parameters were profoundly impaired with large effect sizes (GRS Cohen’s d = 2.46; GCS d = 2.00; GLS d = 1.38). Segmental circumferential strain (SCS) and segmental radial strain (SRS) demonstrated statistically significant discriminative ability for non-viable myocardium (AUC 0.624–0.637); segmental longitudinal strain (SLS) reached significance uniquely for viable scar versus no scar (AUC 0.566). Conclusion CMR-FT provides comprehensive, non-invasive assessment of myocardial deformation in ICM. A multi-strain approach—SCS and SRS for transmural scar identification, SLS for early subendocardial injury—offers clinically meaningful, contrast-independent viability information that complements LGE imaging and supports risk stratification in this population.