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Original Articles: Adult Cardiac

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

^a Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri
^b Willowbrook Cardiovascular Associates, Houston, Texas
^c St. Charles Medical Center and Heart Center, Bend, Oregon
^d Department of Medicine, Duke University Medical Center, Durham, North Carolina

Accepted for publication June 13, 2008.

^_* Address correspondence to Dr Pasque, Barnes-Jewish Hospital, One Barnes-Jewish Hospital Plaza, Suite 3103 Queeny Tower, St. Louis, MO 63110 (Email: pasquem{at}wustl.edu).

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.

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Invited Commentary

Amedeo Anselmi and Carlo Nicola De Cecco
Ann. Thorac. Surg. 2008 86: 1553. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				A. Anselmi and C. N. De Cecco Invited Commentary Ann. Thorac. Surg., November 1, 2008; 86(5): 1553 - 1553. [Full Text] [PDF]