Myocardial deformation imaging based on ultrasonic pixel tracking to identify reversible myocardial dysfunction.
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.
Becker
Michael
M
Department of Cardiology, University Hospital RWTH Aachen, Aachen, Germany.
Lenzen
Alexandra
A
Ocklenburg
Christina
C
Stempel
Katharina
K
Kühl
Harald
H
Neizel
Miria
M
Katoh
Markus
M
Kramann
Rafael
R
Wildberger
Joachim
J
Kelm
Malte
M
Hoffmann
Rainer
R
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
D003287:Contrast Media