Diagnostic accuracy of segmental strain analysis by cardiac magnetic resonance feature tracking for chronic myocardial ischemic scar assessment

Rationale and objective

This study investigates the potential of segmental strain parameters derived from cine magnetic resonance imaging (MRI) using feature tracking (FT) to detect chronic ischemic scars in patients with ischemic heart disease, offering an alternative to late gadolinium enhancement (LGE) MRI, which has limitations such as long scan times and contraindications to gadolinium.

Patients and methods

A total of 47 patients with chronic coronary syndrome and 20 healthy controls were enrolled, with CMR examinations performed on a 1.5 Tesla MRI system. Strain parameters were analyzed from 1072 myocardial segments. Myocardial segments were categorized into four groups: healthy controls, remote myocardium (no late gadolinium enhancement), scarred-viable (<50 % scar transmurality), and nonviable (>50 % scar transmurality).

Results

Results showed significant differences in segmental peak circumferential strain (SPCS), peak radial strain (SPRS), and peak longitudinal strain (SPLS) between scarred viable and nonviable segments compared to remote and control segments, with all p-values <0.001. Specifically, SPCS had a superior ability to distinguish scarred myocardium from remote tissue, showing an area under the curve (AUC) of 0.77, with a sensitivity of 71.5 % and specificity of 70 %. For differentiating nonviable from viable myocardium, SPCS achieved an AUC of 0.80, with a sensitivity of 82.02 % and specificity of 70.21 %.

Conclusion

CMR-FT strain analysis is promising complementary tool, particularly in situations where contrast administration is contraindicated or when a rapid, non-contrast assessment of myocardial viability and potential scar burden is desired.