Displacement encoding with stimulated echoes enables the identification of infarct transmurality early postmyocardial infarction

Abstract

Background Segmental extent of infarction assessed by late gadolinium enhancement (LGE) imaging early post‐ST‐segment elevation myocardial infarction (STEMI) has utility in predicting left ventricular functional recovery. Hypothesis: We hypothesized that segmental circumferential strain with displacement encoding with stimulated echoes (DENSE) would be a stronger predictor of infarct transmurality than feature‐tracking strain, and noninferior to extracellular volume fraction (ECV). Study Type: Prospective. Population: Fifty participants (mean ± SD, 59 ± 9 years, 40 [80%] male) underwent cardiac MRI on day 1 post‐STEMI. Field‐Strength/Sequences: 1. 5T/cine, DENSE , T1 mapping, ECV , LGE. Assessment Two observers assessed segmental percentage LGE extent, presence of microvascular obstruction (MVO), circumferential and radial strain with DENSE and feature‐tracking, T1 relaxation times, and ECV. Statistical Tests: Normality was tested using the Shapiro–Wilk test. Skewed distributions were analyzed utilizing Mann–Whitney or Kruskal–Wallis tests and normal distributed data using independent t ‐tests. Diagnostic cutoff values were identified using the Youden index. The difference in area under the curve was compared using the z‐statistic. Results: Segmental circumferential strain with DENSE was associated with the extent of infarction ≥50% (AUC [95% CI], cutoff value = 0. 9 [0. 8, 0. 9], −10%) similar to ECV (AUC = 0. 8 [0. 8, 0. 9], 37%) (P = 0. 117) and superior to feature‐tracking circumferential strain (AUC = 0. 7[0. 7, 0. 8], −19%) (P  < 0. 05). For the detection of segmental infarction ≥75%, circumferential strain with DENSE (AUC = 0. 9 [0. 8, 0. 9], −10%) was noninferior to ECV (AUC = 0. 8 [0. 7, 0. 9], 42%) (P = 0. 132) and superior to feature‐tracking (AUC = 0. 7 [0. 7, 0. 8], −13%) (P  < 0 VSports app下载. 05). For MVO detection, circumferential strain with DENSE (AUC = 0. 8 [0. 8, 0. 9], −12%) was superior to ECV (AUC = 0. 8 [0. 7, 0. 8] 34%) (P  < 0. 05) and feature‐tracking (AUC = 0. 7 [0. 6, 0. 7] −21%) (P  < 0. 05). Data Conclusion: Circumferential strain with DENSE is a functional measure of infarct severity and may remove the need for gadolinium contrast agents in some circumstances. Level of Evidence: 2 Technical Efficacy Stage: 5.