Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg, Berlin, Germany.
PLoS One. 2021 May 3;16(5):e0251040. doi: 10.1371/journal.pone.0251040. eCollection 2021.
Cardiovascular magnetic resonance (CMR) is the current reference standard for the quantitative assessment of ventricular function. Fast Strain-ENCoded (fSENC)-CMR imaging allows for the assessment of myocardial deformation within a single heartbeat. The aim of this pilot study was to identify obstructive coronary artery disease (oCAD) with fSENC-CMR in patients presenting with new onset of chest pain.
In 108 patients presenting with acute chest pain, we performed fSENC-CMR after initial clinical assessment in the emergency department. The final clinical diagnosis, for which cardiology-trained physicians used clinical information, serial high-sensitive Troponin T (hscTnT) values and-if necessary-further diagnostic tests, served as the standard of truth. oCAD was defined as flow-limiting CAD as confirmed by coronary angiography with typical angina or hscTnT dynamics. Diagnoses were divided into three groups: 0: non-cardiac, 1: oCAD, 2: cardiac, non-oCAD. The visual analysis of fSENC bull´s eye maps (blinded to final diagnosis) resulted in a sensitivity of 82% and specificity of 87%, as well as a negative predictive value of 96% for identification of oCAD. Both, global circumferential strain (GCS) and global longitudinal strain (GLS) accurately identified oCAD (area under the curve/AUC: GCS 0.867; GLS 0.874; p<0.0001 for both), outperforming ECG, hscTnT dynamics and EF. Furthermore, the fSENC analysis on a segmental basis revealed that the number of segments with impaired strain was significantly associated with the patient´s final diagnosis (p<0.05 for all comparisons).
In patients with acute chest pain, myocardial strain imaging with fSENC-CMR may serve as a fast and accurate diagnostic tool for ruling out obstructive coronary artery disease.
心血管磁共振（CMR）是目前评估心室功能的参考标准。快速应变编码（fSENC）-CMR 成像可在单次心跳内评估心肌变形。本研究旨在通过 fSENC-CMR 识别新发胸痛患者中的阻塞性冠状动脉疾病（oCAD）。
在 108 例新发胸痛的患者中，我们在急诊科进行了 fSENC-CMR 检查。经心内科医生采用临床信息、连续高敏肌钙蛋白 T（hscTnT）值以及必要时进一步的诊断性检查进行最终临床诊断，以此作为金标准。oCAD 定义为经冠状动脉造影证实的存在典型心绞痛或 hscTnT 动力学变化的狭窄性 CAD。将诊断分为三组：0：非心脏，1：oCAD，2：心脏，非 oCAD。对 fSENC 牛眼图（blinded to final diagnosis）的视觉分析结果显示，识别 oCAD 的敏感性为 82%，特异性为 87%，阴性预测值为 96%。整体周向应变（GCS）和整体纵向应变（GLS）均能准确识别 oCAD（曲线下面积 AUC：GCS 为 0.867；GLS 为 0.874；两者均 p<0.0001），优于心电图、hscTnT 动力学和 EF。此外，基于节段的 fSENC 分析显示，存在应变受损的节段数与患者的最终诊断显著相关（p<0.05 所有比较）。
在新发胸痛患者中，fSENC-CMR 心肌应变成像可作为一种快速准确的诊断工具，用于排除阻塞性冠状动脉疾病。
