Cardiovascular magnetic resonance myocardial feature tracking for quantitative viability assessment in ischemic cardiomyopathy

Background: Low dose dobutamine stress magnetic resonance imaging is valuable to assess viability in patients with ischemic cardiomyopathy. Analysis is usually qualitative with considerable operator dependency. The aim of the current study was to investigate the feasibility of cine images derived quantitative cardiac magnetic resonance (CMR) myocardial feature tracking (FT) strain parameters to assess viability in patients with ischemic cardiomyopathy. Methods: 15 consecutive patients with ischemic cardiomyopathy referred for viability assessment were studied at 3 T at rest and during low dose dobutamine stress (5 and 10 mu g/kg/min of dobutamine). Subendocardial and subepicardial circumferential (Eccendo and Eccepi) and radial (Err) strains were assessed using steady state free precession (SSFP) cine images orientated in 3 short axis slices covering 16 myocardial segments. Results: Dysfunctional segments without scar (n=75) improved in all three strain parameters: Ecc(endo) (Rest: -10.5 +/- 6.9; 5 mu g: -12.1 +/- 6.9; 10 mu g: -14.1 +/- 9.2; p<0.05), Ecc(epi) (Rest: -7 +/- 4.8; 5 mu g: -8.2 +/- 5.5; 10 mu g: -9.1 +/- 5.9; p<0.05) and Err (Rest: 11.7 +/- 8.3; 5 mu g: 16 +/- 10.9; 10 mu g: 16.5 +/- 12.8; p<0.05). There was no response to dobutamine in dysfunctional segments with scar transmurality above 75% (n=6): Ecc(endo) (Rest: -4.7 +/- 3.0; 5 mu g: -2.9 +/- 2.5; 10 mu g: -6.6 +/- 3.3; p=ns), Ecc(epi) (Rest: -2.9 +/- 2.9; 5 mu g: -5.4 +/- 3.9; 10 mu g: -4.5 +/- 4.2; p=ns) and Err (Rest: 9.5 +/- 5; 5 mu g: 5.4 +/- 6.2; 10 mu g: 4.9 +/- 3.3; p=ns). Circumferential strain (Ecc(endo), Ecc(epi)) improved in all segments up to a transmurality of 75% (n= 60; p<0.05). Err improved in segments <50% transmurality (n=45; p<0.05) and remained unchanged above 50% transmurality (n=21; p=ns). Conclusions: CMR-FT is a novel technique, which detects quantitative wall motion derived from SSFP cine imaging at rest and with low dose dobutamine stress. CMR-FT holds promise of quantitative assessment of viability in patients with ischemic cardiomyopathy. (C) 2011 Elsevier Ireland Ltd. All rights reserved.