Quantitative circumferential strain analysis using adenosine triphosphate-stress/rest 3-T tagged magnetic resonance to evaluate regional contractile dysfunction in ischemic heart disease

•Infarcted segments could be differentiated from non-ischemic and ischemic segments with high sensitivity and specificity under at rest conditions.•The time-to-peak circumferential strain values in infarcted segments were more significantly delayed than those in non-ischemic and ischemic segments.•Both circumferential strain and circumferential systolic strain rate values under ATP-stress conditions were significantly lower in ischemic segments than in non-ischemic segments.•Subtracting stress and rest circumferential strain had a higher diagnostic capability for ischemia relative to only utilizing rest or ATP-stress circumferential strain values.•A circumferential strain analysis using tagged MR can quantitatively assess contractile dysfunction in ischemic and infarcted myocardium.

PurposeWe 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.MethodsIn 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.ResultsA 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 477.3 ms 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.ConclusionsCircumferential strain analysis using tagged MR can quantitatively assess contractile dysfunction in ischemic and infarcted myocardium.