Department of Cardiology, Angiology and Pneumology, University Clinic of Heidelberg, Heidelberg, Germany.
Department of Cardiology and Angiology, Robert-Bosch-Hospital, Stuttgart, Germany.
BMC Med Imaging. 2022 Sep 5;22(1):159. doi: 10.1186/s12880-022-00886-3.
Myocardial strain imaging has gained importance in cardiac magnetic resonance (CMR) imaging in recent years as an even more sensitive marker of early left ventricular dysfunction than left-ventricular ejection fraction (LVEF). fSENC (fast strain encoded imaging) and FT (feature tracking) both allow for reproducible assessment of myocardial strain. However, left-ventricular long axis strain (LVLAS) might enable an equally sensitive measurement of myocardial deformation as global longitudinal or circumferential strain in a more rapid and simple fashion.
In this study we compared the diagnostic performance of fSENC, FT and LVLAS for identification of cardiac pathology (ACS, cardiac-non-ACS) in patients presenting with chest pain (initial hscTnT 5-52 ng/l). Patients were prospectively recruited from the chest pain unit in Heidelberg. The CMR scan was performed within 1 h after patient presentation. Analysis of LVLAS was compared to the GLS and GCS as measured by fSENC and FT.
In total 40 patients were recruited (ACS n = 6, cardiac-non-ACS n = 6, non-cardiac n = 28). LVLAS was comparable to fSENC for differentiation between healthy myocardium and myocardial dysfunction (GLS-fSENC AUC: 0.882; GCS-fSENC AUC: 0.899; LVLAS AUC: 0.771; GLS-FT AUC: 0.740; GCS-FT: 0.688), while FT-derived strain did not allow for differentiation between ACS and non-cardiac patients. There was significant variability between the three techniques. Intra- and inter-observer variability (OV) was excellent for fSENC and FT, while for LVLAS the agreement was lower and levels of variability higher (intra-OV: Pearson > 0.7, ICC > 0.8; inter-OV: Pearson > 0.65, ICC > 0.8; CoV > 25%).
While reproducibility was excellent for both FT and fSENC, it was only fSENC and the LVLAS which allowed for significant identification of myocardial dysfunction, even before LVEF, and therefore might be used as rapid supporting parameters for assessment of left-ventricular function.
心肌应变成像在近几年心脏磁共振（CMR）成像中变得越来越重要，作为一种比左心室射血分数（LVEF）更敏感的早期左心室功能障碍标志物。快速应变成像（fSENC）和特征追踪（FT）都可以进行重复性的心肌应变评估。然而，左心室长轴应变（LVLAS）可能以更快速、更简单的方式实现对心肌变形的敏感性测量，与整体纵向应变或圆周应变具有同等的敏感性。
在这项研究中，我们比较了 fSENC、FT 和 LVLAS 对因胸痛就诊（初始 hs cTnT 5-52ng/L）且有或无心脏疾病（ACS、心脏非 ACS）患者的心脏病理学的诊断性能。患者前瞻性地从海德堡胸痛单元招募。CMR 扫描在患者就诊后 1 小时内进行。LVLAS 的分析与 fSENC 和 FT 测量的 GLS 和 GCS 进行比较。
共招募了 40 名患者（ACS 组 n=6，心脏非 ACS 组 n=6，非心脏组 n=28）。LVLAS 可与 fSENC 相媲美，用于区分健康心肌和心肌功能障碍（GLS-fSENC AUC：0.882；GCS-fSENC AUC：0.899；LVLAS AUC：0.771；GLS-FT AUC：0.740；GCS-FT：0.688），而 FT 衍生的应变无法区分 ACS 和非心脏患者。三种技术之间存在显著差异。fSENC 和 FT 的观察者内和观察者间变异性（OV）均良好，而 LVLAS 的一致性较低，变异性水平较高（观察者内 OV：Pearson>0.7，ICC>0.8；观察者间 OV：Pearson>0.65，ICC>0.8；CV>25%）。
虽然 FT 和 fSENC 的可重复性都很好，但只有 fSENC 和 LVLAS 能够显著识别心肌功能障碍，甚至在 LVEF 之前，因此可作为左心室功能评估的快速支持参数。
