Layer-specific analysis of myocardial deformation for assessment of infarct transmurality: comparison of strain-encoded cardiovascular magnetic resonance with 2D speckle tracking echocardiography.

AIMS: Separate analysis of endocardial and epicardial myocardial layer deformation has become possible using strain-encoded cardiovascular magnetic resonance (SENC) and 2D-dimensional speckle tracking echocardiography (Echo). This study evaluated and compared both modalities for the assessment of infarct transmurality as defined by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR). METHODS AND RESULTS: In 29 patients (age 62.4 ± 11.7 years, 23 male) with ischaemic cardiomyopathy, SENC using 1.5 T CMR and Echo were performed. Peak circumferential systolic strain of the endocardial and the epicardial layer of 304 myocardial segments was assessed by SENC and by Echo. The segmental transmurality of myocardial infarction was determined as relative amount of LGE (0%: no infarction; 1-50%: non-transmural infarction; 51-100%: transmural infarction). Endocardial and epicardial strain defined by SENC and by Echo differed significantly between segments of different infarct transmurality determined by CMR. Endocardial layer circumferential strain analysis by Echo and by SENC allowed distinction of segments with non-transmural infarction from non-infarcted segments with similar accuracy [area under the curve (AUC) 0.699 vs. 0.649, respectively, P = 0.239]. Epicardial layer circumferential strain analysis by Echo and by SENC allowed distinction of transmural from non-transmural myocardial infarction defined by LGE CMR with similar accuracy (AUC 0.721 vs. 0.664, respectively, P = 0.401). Endocardial strain by SENC correlated moderately with endocardial strain by Echo (r = 0.50; standard error of estimate = 5.2%). CONCLUSION: Layer-specific analysis of myocardial deformation by Echo and by SENC allows discrimination between different transmurality categories of myocardial infarction with similar accuracy. However, accuracy of both methods is non-optimal, indicating that further tools for improvement should be evaluated in the future.

Quantitative analysis of endocardial and epicardial left ventricular myocardial deformation-comparison of strain-encoded cardiac magnetic resonance imaging with two-dimensional speckle-tracking echocardiography.

BACKGROUND: Quantitative analysis of segmental myocardial deformation of different myocardial layers has become possible using strain-encoded cardiac magnetic resonance imaging (SENC) and speckle-tracking echocardiography (STE). We evaluated and compared the quantitative analysis of myocardial deformation using SENC and STE. METHODS: In 44 patients (age 61 ± 13 years, 34 men), SENC by cardiac magnetic resonance imaging using a 1.5-Tesla whole-body scanner and two-dimensional STE were performed prospectively. Quantitative layer-specific analysis of segmental left ventricular function was performed to determine the peak circumferential and peak longitudinal systolic strain values using SENC and STE of an endocardial and epicardial myocardial layer. In addition, segmental function was defined as normokinetic, hypokinetic, or akinetic by visual analysis of the magnetic resonance imaging cine sequences. RESULTS: The endocardial and epicardial strain defined by SENC or STE differed significantly between the visually defined segmental function states. The correlation of the peak circumferential endocardial strain by SENC versus STE (intraclass correlation coefficient [ICC] 0.493, 95% CI 0.358-0.597) tended to be better than the correlation of the circumferential epicardial strain using both methods (ICC 0.321, 95% CI 0.238-0.399). The correlation of the peak longitudinal endocardial strain by SENC and STE was similar (ICC 0.472, 95% CI 0.398-0.541), in contrast to the longitudinal epicardial strain analysis by both techniques (ICC 0.554, 95% CI 0.417-0.655). Circumferential strain analysis by STE allowed better distinction of the hypokinetic or akinetic segments from the normokinetic segments than did the circumferential strain analysis by SENC of the endocardial layer (area under the receiver operating characteristic curve [AUC ROC] 0.946 vs 0.884; P < .001) or epicardial layer (AUC ROC 0.884 vs 0.782; P < .001). Longitudinal strain analysis using STE and SENC of the endocardial layer (AUC ROC 0.851 vs 0.839; P = .5838) and epicardial layer (AUC ROC 0.849 vs 0.833; P = .4321) had similar diagnostic value for identifying the presence of hypokinetic and akinetic segments. CONCLUSIONS: Quantitative analysis of segmental deformation by SENC and STE allowed accurate distinction of myocardial segments with different functional states. Circumferential endocardial strain analysis by STE allowed the best distinction of segments with impaired function from the normokinetic segments.