CAD: Acute Coronary Syndromes

1348635 - Global and Regional Strain to Predict Ischemic LGE in Acute and Chronic ST-elevation Myocardial Infarction

Wednesday, January 25, 2023

Location: E-POSTER

Presenting Author(s)

Jennifer Erley, MD

Resident Doctor
University Medical Center Hamburg-Eppendorf
Hamburg, Berlin, Germany

Primary Author(s)

Jennifer Erley, MD

Resident Doctor
University Medical Center Hamburg-Eppendorf
Hamburg, Berlin, Germany

Co-Author(s)

Jitka Starekova, MD

Scientist
University of Wisconsin-Madison
Hamburg, Hamburg, United States
MS

Martin Sinn, MD

Resident Doctor
University Medical Center Hamburg-Eppendorf
Hamburg , Hamburg, Germany
KM

Kai Muellerleile, MD

Senior Physician
University Medical Center Hamburg-Eppendorf, Germany
IM

Isabel Molwitz, MD

Resident Doctor
University Medical Center Hamburg-Eppendorf, Germany
HC

Hang Chen, MD

Ph.D. student
University Medical Center Hamburg-Eppendorf, Germany
PH

Phillip Harms

Resident Doctor
University Medical Center Hamburg-Eppendorf, Germany
MM

Mathias Meyer, MD

Senior Physician
University Medical Center Hamburg-Eppendorf, Germany
EC

Ersin Cavus, MD

Resident Doctor
University Medical Center Hamburg-Eppendorf
Hamburg, Hamburg, Germany
JS

Jan Schneider, MD

Resident Doctor
University Medical Center Hamburg-Eppendorf, Germany
SB

Stefan Blankenberg, MD

Director of the Cardiology Department
University Medical Center Hamburg-Eppendorf, Hamburg, Germany
GL

Gunnar Lund, MD

Senior Physician
University Medical Center Hamburg-Eppendorf, Hamburg, Germany
GA

Gerhard Adam, MD

Director of the Radiology Department
University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Enver G. Tahir, MD

Senior physician
University Medical Center Hamburg-Eppendorf
Hamburg, Hamburg, Germany

Background: Strain is an important imaging parameter to assess global and regional myocardial deformation. This study aims at monitoring left ventricular (LV) myocardial strain from acute to chronic ST-elevation myocardial infarction (STEMI) and determine its ability to predict late gadolinium enhancement (LGE).

Methods: Patients prospectively underwent a baseline (BL) cardiac magnetic resonance imaging (CMR) on a 1.5T scanner (Achieva, Philips) at 8±5 days after STEMI, and at 6(±1.4)-month follow-up (FU). The imaging protocol included steady-state free precession (SSFP) sequences in long- and short-axis and LGE imaging. Feature-tracking (FT) (Segment, Medviso) analysis was conducted to determine myocardial strain. Myocardial segments were grouped in three categories according to the LGE pattern at BL: negative (LGE-), non-transmural (LGE+) and transmural (LGE++).

Results: 32 patients participated in this prospective study (81% male; age 59±10 years). Global and segmental left-ventricular longitudinal (GLS/SLS), radial (GLS/SRS) and circumferential (GCS/SCS) strain improved from BL

to FU: GLS from -14±4% to -16±4%, p< 0.001; GCS from -15±4% to -16±4%, p=0.023; GRS from 38±11% to 42±13%, p=0.006. As given in Table 1, regional strain remained impaired in LGE+ and LGE ++ segments. Figure 1 displays the receiver operating characteristic (ROC) curves on the ability of regional strain to predict LGE. Especially SCS distinguished LGE- from LGE +/++ segments (SLS: area under the curve (AUC)=0.66 [95% confidence interval (CI) 0.61-0.71], p< 0.001; SRS: AUC=0.75 [0.70-0.79], p< 0.001; SCS: AUC=0.77 [0.73-0.82], p< 0.001). Using a cut-off value of -17%, LV SCS at baseline would predict segmental LGE with a sensitivity of 85% and a specificity of 45%, while LV SLS would predict LGE with a sensitivity of 78% and a specificity of 41%. Using a cut-off value of 35%, LV SRS at baseline would predict segmental LGE with a sensitivity of 83% and a specificity of 47%.

Conclusion: Strain improved from acute to chronic STEMI, but regional strain remained impaired in LGE-positive myocardial segments. Especially circumferential strain was able to predict focal LGE following STEMI with high sensitivity and moderate specificity. Strain may serve as an imaging biomarker to analyze myocardial viability.