Department of Cardiology, Pneumology and Angiology, University Hospital RWTH Aachen, Aachen, Germany.
Eur Heart J Cardiovasc Imaging. 2013 Jun;14(6):570-8. doi: 10.1093/ehjci/jes229. Epub 2012 Nov 12.
Separate analysis of endocardial and epicardial myocardial layer deformation has become possible using strain-encoded cardiovascular magnetic resonance (SENC) and 2D-dimensional speckle tracking echocardiography (Echo). This study evaluated and compared both modalities for the assessment of infarct transmurality as defined by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR).
In 29 patients (age 62.4 ± 11.7 years, 23 male) with ischaemic cardiomyopathy, SENC using 1.5 T CMR and Echo were performed. Peak circumferential systolic strain of the endocardial and the epicardial layer of 304 myocardial segments was assessed by SENC and by Echo. The segmental transmurality of myocardial infarction was determined as relative amount of LGE (0%: no infarction; 1-50%: non-transmural infarction; 51-100%: transmural infarction). Endocardial and epicardial strain defined by SENC and by Echo differed significantly between segments of different infarct transmurality determined by CMR. Endocardial layer circumferential strain analysis by Echo and by SENC allowed distinction of segments with non-transmural infarction from non-infarcted segments with similar accuracy [area under the curve (AUC) 0.699 vs. 0.649, respectively, P = 0.239]. Epicardial layer circumferential strain analysis by Echo and by SENC allowed distinction of transmural from non-transmural myocardial infarction defined by LGE CMR with similar accuracy (AUC 0.721 vs. 0.664, respectively, P = 0.401). Endocardial strain by SENC correlated moderately with endocardial strain by Echo (r = 0.50; standard error of estimate = 5.2%).
Layer-specific analysis of myocardial deformation by Echo and by SENC allows discrimination between different transmurality categories of myocardial infarction with similar accuracy. However, accuracy of both methods is non-optimal, indicating that further tools for improvement should be evaluated in the future.
使用应变编码心血管磁共振（SENC）和二维斑点追踪超声心动图（Echo），已经可以分别分析心内膜和心外膜心肌层的变形。本研究评估并比较了这两种方法，以评估由晚期钆增强心血管磁共振（CMR）定义的梗塞透壁程度。
在 29 名缺血性心肌病患者（年龄 62.4±11.7 岁，23 名男性）中，进行了 1.5 T CMR 的 SENC 和 Echo 检查。通过 SENC 和 Echo 评估了 304 个心肌节段的心内膜和心外膜层的峰值周向收缩应变。心肌梗塞的节段透壁程度通过 LGE（0%：无梗塞；1-50%：非透壁梗塞；51-100%：透壁梗塞）的相对量来确定。由 CMR 确定的不同梗塞透壁程度的节段之间，SENC 和 Echo 定义的心内膜和心外膜应变差异显著。Echo 和 SENC 的心内膜层周向应变分析可以准确地区分非透壁梗塞节段和非梗塞节段[曲线下面积（AUC）分别为 0.699 和 0.649，P=0.239]。Echo 和 SENC 的心外膜层周向应变分析可以准确地区分由 LGE CMR 定义的透壁和非透壁心肌梗塞[AUC 分别为 0.721 和 0.664，P=0.401]。SENC 的心内膜应变与 Echo 的心内膜应变中度相关（r=0.50；估计标准误差=5.2%）。
Echo 和 SENC 的心肌变形层特异性分析可以以相似的准确性区分不同的透壁性梗塞类别。然而，这两种方法的准确性都不是最优的，这表明未来应该评估进一步提高准确性的方法。
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