Discipline of Medicine, University of Adelaide, Adelaide, Australia,
Eur Radiol. 2014 Jun;24(6):1219-28. doi: 10.1007/s00330-014-3137-6. Epub 2014 Apr 12.
We evaluate whether circumferential strain derived from grid-tagged CMR is a better method for assessing improvement in segmental contractile function after STEMI compared to late gadolinium enhancement (LGE).
STEMI patients post primary PCI underwent baseline CMR (day 3) and follow-up (day 90). Cine, grid-tagged and LGE images were acquired. Baseline LGE infarct hyperenhancement was categorised as ≤25 %, 26-50 %, 51-75 % and >75 % hyperenhancement. The segmental baseline circumferential strain (CS) and circumferential strain rate (CSR) were calculated from grid-tagged images. Segments demonstrating an improvement in wall motion of ≥1 grade compared to baseline were regarded as having improved segmental contractile-function.
Forty-five patients (aged 58 ± 12 years) and 179 infarct segments were analysed. A baseline CS cutoff of -5 % had sensitivity of 89 % and specificity of 70 % for detection of improvement in segmental-contractile-function. On receiver-operating characteristic analysis for predicting improvement in contractile function, AUC for baseline CS (0.82) compared favourably to LGE hyperenhancement (0.68), MVO (0.67) and baseline-CSR (0.74). On comparison of AUCs, baseline CS was superior to LGE hyperenhancement and MVO in predicting improvement in contractile function (P < 0.001). On multivariate-analysis, baseline CS was the independent predictor of improvement in segmental contractile function (P < 0.001).
Grid-tagged CMR-derived baseline CS is a superior predictor of improvement in segmental contractile function, providing incremental value when added to LGE hyperenhancement and MVO following STEMI.
Baseline CS predicts contractile function recovery better than LGE and MVO following STEMI. Baseline CS predicts contractile function recovery better than baseline CSR following STEMI. Baseline CS provides incremental value to LGE and MVO following STEMI.
我们评估网格标记 CMR 得出的周向应变是否优于晚期钆增强（LGE），是一种评估 STEMI 后节段收缩功能改善的更好方法。
STEMI 患者行直接经皮冠状动脉介入治疗（primary PCI）后，分别在基线（第 3 天）和随访（第 90 天）时进行 CMR 检查。采集电影、网格标记和 LGE 图像。基线 LGE 梗死区高增强分为≤25%、26-50%、51-75%和>75%。从网格标记图像计算基线节段周向应变（CS）和周向应变率（CSR）。与基线相比，壁运动改善≥1 级的节段被认为节段收缩功能改善。
分析了 45 例（年龄 58±12 岁）和 179 个梗死节段。基线 CS 截断值为-5%时，检测节段收缩功能改善的敏感性为 89%，特异性为 70%。基线 CS 预测收缩功能改善的受试者工作特征曲线下面积（AUC）为 0.82，优于 LGE 高增强（0.68）、微出血体积（MVO）（0.67）和基线-CSR（0.74）。AUC 比较显示，基线 CS 在预测收缩功能改善方面优于 LGE 高增强和 MVO（P<0.001）。多变量分析显示，基线 CS 是节段收缩功能改善的独立预测因子（P<0.001）。
网格标记 CMR 衍生的基线 CS 是节段收缩功能改善的更好预测因子，在 STEMI 后添加 LGE 高增强和 MVO 时具有附加价值。
基线 CS 预测 STEMI 后节段收缩功能恢复优于 LGE 和 MVO。基线 CS 预测 STEMI 后节段收缩功能恢复优于基线 CSR。基线 CS 在 STEMI 后提供 LGE 和 MVO 的附加价值。
