Myocardial Viability Mapping by Magnetic Resonance-Based Multiparametric Systolic Strain Analysis

• Published in: The Annals of thoracic surgery Vol. 86; no. 5; pp. 1546 - 1553
• Main Authors: Cupps, Brian P., PhD, Bree, Douglas R., MD, Wollmuth, Jason R., MD, Howells, Analyn C., RN, Voeller, Rochus K., MD, Rogers, Joseph G., MD, Pasque, Michael K., MD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.11.2008
• Subjects: Cardiothoracic Surgery; Confidence Intervals; Female; Humans; Magnetic Resonance Imaging - methods; Male; Middle Aged; Models, Cardiovascular; Myocardial Contraction; Myocardial Ischemia - pathology; Myocardial Ischemia - physiopathology; Myocardium - cytology; Myocardium - pathology; Reference Values; ROC Curve; Stress, Physiological; Surgery; Systole; Tissue Survival; 30
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2008.06.072

Background Regional myocardial contractility can be characterized by three-dimensional left ventricular (LV) multiparametric strain maps generated from sequential magnetic resonance imaging of radiofrequency tissue-tagging grid point displacements. Methods Normal average and standard deviation values for each of three strain indices at 15,300 LV points were determined from a normal volunteer human strain database (n = 50) by application of magnetic resonance–based three-dimensional strain analysis. Patient-specific multiparametric strain data from each ischemic cardiomyopathy patient (n = 20) were then submitted to a point-by-point comparison (n = 15,300 LV points) to the normal strain database. The resulting 15,300 composite multiparametric Z-score values (standard deviation from normal average) were color-contour mapped over patient-specific three-dimensional LV geometry to detect the abnormal contractile patterns associated with myocardial infarction and nonviable myocardium. Results The average multiparametric strain composite Z-score from each LV region (n = 120) was compared with the respective clinical standard viability testing result and used to construct a receiver-operator characteristic curve. The area under the curve was 0.941 ( p < 0.001; 95% confidence interval: 0.897 to 0.985). A regional average Z-score threshold of 1.525 (> 1.525 being nonviable) resulted in a sensitivity of 90% and a specificity of 90%. Corresponding positive and negative predictive values were 84% and 95%, respectively. Conclusions The clinical application of magnetic resonance–based multiparametric strain analysis allowed accurate regional characterization and visualization of LV myocardial viability.