title: Quantitative circumferential strain analysis using adenosine triphosphate-stress/rest 3-T tagged magnetic resonance to evaluate regional contractile dysfunction in ischemic heart disease.
abstract: OBJECTIVE
  We evaluated whether a quantitative circumferential strain (CS) analysis using adenosine triphosphate (ATP)-stress/rest 3-T tagged magnetic resonance (MR) imaging can depict myocardial ischemia as contractile dysfunction during stress in patients with suspected coronary artery disease (CAD). We evaluated whether it can differentiate between non-ischemia, myocardial ischemia, and infarction. We assessed its diagnostic performance in comparison with ATP-stress myocardial perfusion MR and late gadolinium enhancement (LGE)-MR imaging.
  
  
  METHODS
  In 38 patients suspected of having CAD, myocardial segments were categorized as non-ischemic (n=485), ischemic (n=74), or infarcted (n=49) from the results of perfusion MR and LGE-MR. The peak negative CS value, peak circumferential systolic strain rate (CSR), and time-to-peak CS were measured in 16 segments.
  
  
  RESULTS
  A cutoff value of -12.0% for CS at rest allowed differentiation between infarcted and other segments with a sensitivity of 79%, specificity of 76%, accuracy of 76%, and an area under the curve (AUC) of 0.81. Additionally, a cutoff value of 477.3ms for time-to-peak CS at rest allowed differentiation between infarcted and other segments with a sensitivity of 61%, specificity of 91%, accuracy of 88%, and an AUC of 0.75. The differences in CS values between ATP-stress and rest conditions (ΔCS) in non-ischemic segments (median [first quartile, third quartile] -1.7 [-3.2, -0.1] %) were smaller than in segments with ischemia (+1.1 [+0.3, +2.3] %, p<0.001). A cutoff value of +0.3% for the ΔCS value could differentiate segments with ischemia from non-ischemic segments with a sensitivity of 75%, a specificity of 82%, an accuracy of 82%, and an AUC of 0.86.
  
  
  CONCLUSIONS
  Circumferential strain analysis using tagged MR can quantitatively assess contractile dysfunction in ischemic and infarcted myocardium.
authors.affiliation: Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon-city, Ehime 791-0295, Japan. Electronic address: m.nakamura1230@gmail.com.
authors.forename: Masashi
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: Department of Radiology, Saiseikai Matsuyama Hospital, Ehime 791-0295, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Kido
authors.affiliation: Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon-city, Ehime 791-0295, Japan.
authors.forename: Teruhito
authors.initials: T
authors.lastname: Kido
authors.affiliation: Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon-city, Ehime 791-0295, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Tanabe
authors.affiliation: Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon-city, Ehime 791-0295, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Matsuda
authors.affiliation: Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon-city, Ehime 791-0295, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Nishiyama
authors.affiliation: Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon-city, Ehime 791-0295, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Miyagawa
authors.affiliation: Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon-city, Ehime 791-0295, Japan.
authors.forename: Teruhito
authors.initials: T
authors.lastname: Mochizuki
mesh_terms: D000255:Adenosine Triphosphate; D000368:Aged; D019540:Area Under Curve; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006321:Heart / Q000503:physiopathology; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000503:physiopathology*; D015203:Reproducibility of Results; D012146:Rest; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D003287:Contrast Media; D000255:Adenosine Triphosphate; D019786:Gadolinium DTPA
keywords: Circumferential strain; Magnetic resonance imaging; Myocardial infarction; Myocardial ischemia; Tagged MR