title: Myocardial deformation imaging based on ultrasonic pixel tracking to identify reversible myocardial dysfunction.
abstract: OBJECTIVE
  This study evaluated the predictive value of myocardial deformation imaging for improvement in cardiac function after revascularization therapy in comparison with contrast-enhanced cardiac magnetic resonance imaging (ceMRI).
  
  
  BACKGROUND
  Myocardial deformation imaging allows analysis of myocardial viability in ischemic left ventricular dysfunction.
  
  
  METHODS
  In 53 patients with ischemic left ventricular dysfunction, myocardial viability was assessed using pixel-tracking-derived myocardial deformation imaging and ceMRI to predict recovery of function at 9 +/- 2 months follow-up. For each left ventricular segment in a 16-segment model, peak systolic radial strain was determined from parasternal 2-dimensional echocardiographic views using an automatic frame-by-frame tracking system of natural acoustic echocardiographic markers (EchoPAC, GE Ultrasound, Horton, Norway), and the relative extent of hyperenhancement using ceMRI.
  
  
  RESULTS
  Of 463 segments with abnormal baseline function, 227 showed regional recovery. Compared with segments showing functional improvement, those that failed to recover had lower peak radial strain (15.2 +/- 7.5% vs. 22.6 +/- 6.3%; p < 0.001) and a greater extent of hyperenhancement (56 +/- 29% vs. 14 +/- 17%; p < 0.001). Using a cutoff of 17.2% for peak systolic radial strain, functional recovery could be predicted with high accuracy (sensitivity 70.2%, specificity 85.1%, area under the curve 0.859, 95% confidence interval 0.825 to 0.893). The predictive value was similar to that of hyperenhancement by ceMRI (sensitivity 71.6%, specificity 92.1%, area under the curve 0.874, 95% confidence interval 0.840 to 0.901, at a cutoff of 43% hyperenhancement).
  
  
  CONCLUSIONS
  Myocardial deformation imaging based on frame-to-frame tracking of acoustic markers in 2-dimensional echocardiographic images is a powerful novel modality to identify reversible myocardial dysfunction.
authors.affiliation: Department of Cardiology, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Becker
authors.forename: Alexandra
authors.initials: A
authors.lastname: Lenzen
authors.forename: Christina
authors.initials: C
authors.lastname: Ocklenburg
authors.forename: Katharina
authors.initials: K
authors.lastname: Stempel
authors.forename: Harald
authors.initials: H
authors.lastname: Kühl
authors.forename: Miria
authors.initials: M
authors.lastname: Neizel
authors.forename: Markus
authors.initials: M
authors.lastname: Katoh
authors.forename: Rafael
authors.initials: R
authors.lastname: Kramann
authors.forename: Joachim
authors.initials: J
authors.lastname: Wildberger
authors.forename: Malte
authors.initials: M
authors.lastname: Kelm
authors.forename: Rainer
authors.initials: R
authors.lastname: Hoffmann
mesh_terms: D019540:Area Under Curve; D003287:Contrast Media; D004452:Echocardiography / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000601:surgery / Q000628:therapy; D009204:Myocardial Revascularization; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000601:surgery / Q000628:therapy
chemical_list: D003287:Contrast Media