title: The role of left ventricular deformation in the assessment of microvascular obstruction and intramyocardial haemorrhage.
abstract: In the setting of acute ST-elevation myocardial infarction (STEMI), it remains unclear which strain parameter most strongly correlates with microvascular obstruction (MVO) or intramyocardial haemorrhage (IMH). We aimed to investigate the association of MVO, IMH and convalescent left ventricular (LV) remodelling with strain parameters measured with cardiovascular magnetic resonance (CMR). Forty-three patients with reperfused STEMI and 10 age and gender matched healthy controls underwent CMR within 3-days and at 3-months following reperfused STEMI. Cine, T2-weighted, T2*-imaging and late gadolinium enhancement (LGE) imaging were performed. Infarct size, MVO and IMH were quantified. Peak global longitudinal strain (GLS), global radial strain (GRS), global circumferential strain (GCS) and their strain rates were derived by feature tracking analysis of LV short-axis, 4-chamber and 2-chamber cines. All 43 patients and ten controls completed the baseline scan and 34 patients completed 3-month scans. In multivariate regression, GLS demonstrated the strongest association with MVO or IMH (beta = 0.53, p < 0.001). The optimal cut-off value for GLS was -13.7% for the detection of MVO or IMH (sensitivity 76% and specificity 77.8%). At follow up, 17% (n = 6) of patients had adverse LV remodeling (defined as an absolute increase of LV end-diastolic/end-systolic volumes >20%). Baseline GLS also demonstrated the strongest diagnostic performance in predicting adverse LV remodelling (AUC = 0.79; 95% CI 0.60-0.98; p = 0.03). Post-reperfused STEMI, baseline GLS was most closely associated with the presence of MVO or IMH. Baseline GLS was more strongly associated with adverse LV remodelling than other CMR parameters.
authors: Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
authors: Pankaj
authors: http://orcid.org/0000-0002-5483-169X
authors: P
authors: Garg
authors: Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
authors: Ananth
authors: A
authors: Kidambi
authors: Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
authors: Peter P
authors: PP
authors: Swoboda
authors: Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
authors: James R J
authors: JR
authors: Foley
authors: Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
authors: Tarique A
authors: TA
authors: Musa
authors: Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
authors: David P
authors: DP
authors: Ripley
authors: Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
authors: Bara
authors: B
authors: Erhayiem
authors: Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
authors: Laura E
authors: LE
authors: Dobson
authors: Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
authors: Adam K
authors: AK
authors: McDiarmid
authors: Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
authors: Graham J
authors: GJ
authors: Fent
authors: Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.
authors: Philip
authors: P
authors: Haaf
authors: Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
authors: John P
authors: JP
authors: Greenwood
authors: Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. S.Plein@leeds.ac.uk.
authors: Sven
authors: S
authors: Plein
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena; D016022:Case-Control Studies; D003287:Contrast Media / Q000008:administration & dosage; D003326:Coronary Circulation; D005260:Female; D006470:Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009200:Myocardial Contraction; D054318:No-Reflow Phenomenon / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D013314:Stress, Mechanical; D013997:Time Factors; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
chemical_list: D003287:Contrast Media
keywords: Cardiovascular magnetic resonance; Haemorrhage; Left ventricular function; Myocardial infarction