Published Online
on January 26, 2009

A more recent version of this article appeared on March 1, 2009

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Original Article

Strain-Encoded Cardiac Magnetic Resonance Imaging as an Adjunct for Dobutamine Stress Testing. Incremental Value to Conventional Wall Motion Analysis.

Grigorios Korosoglou^1,3; Dirk Lossnitzer¹; Dieter Schellberg¹; Antje Lewien¹; Angela Wochele¹; Tim Schaeufele¹; Mirja Neizel¹; Henning Steen¹; Evangelos Giannitsis¹; Hugo A. Katus¹ and Nael F. Osman²

¹ University of Heidelberg, Heidelberg, Germany;
² The Johns Hopkins University School of Medicine, Baltimore, Maryland

³ E-mail: grigorios.korosoglou{at}med.uni-heidelberg.de

Background—High-dose dobutamine stress magnetic resonance imaging (DS-MRI) is safe and feasible for the diagnosis of coronary artery disease (CAD) in humans. However, the assessment of cine scans relies on the visual interpretation of regional wall motion, which is subjective. Recently, Strain-Encoded MRI (SENC) has been proposed for the direct color-coded visualization of myocardial strain. The purpose of our study was to compare the diagnostic value of SENC to that provided by conventional wall motion analysis for the detection of inducible ischemia during DS-MRI.

Methods and Results—Stress induced ischemia was assessed by wall motion analysis and by SENC in 101 patients with suspected or known CAD and in 17 healthy volunteers who underwent DS-MRI in a clinical 1.5T scanner. Quantitative coronary angiography deemed as the standard reference for the presence or absence of significant CAD (50% diameter stenosis). On a coronary vessel level, SENC detected inducible ischemia in 86/101 versus 71/101 diseased coronary vessels (p<0.01 versus cine), and showed normal strain response in 189/202 versus 194/202 vessels with <50% stenosis (p=NS versus cine). On a patient level, SENC detected inducible ischemia in 63/64 versus 55/64 patients with CAD (p<0.05 versus cine), and showed normal strain response in 32/37 versus 34/37 patients without CAD (p=NS versus cine).Quantification analysis demonstrated a significant correlation between strain rate reserve (SRreserve) and coronary artery stenosis severity (r²=0.56, p<0.001), and a cut-off value of SRreserve=1.64 deemed as a highly accurate marker for the detection of stenosis50% (AUC=0.96, SE=0.01, 95% CI = 0.94-0.98, p<0.001).

Conclusions—The direct color-coded visualization of strain on MR-images is a useful adjunct for DS-MRI, which provides incremental value for the detection of CAD compared to conventional wall motion readings on cine images.

Key Words: coronary disease • inotropic agents • ischemia • stress • Strain-Encoded MRI • dobutamine stress MRI • inducible ischemia • myocardial strain response • strain rate reserve

Related Article

Strain-Encoded Cardiac MRI as an Adjunct for Dobutamine Stress Testing: Incremental Value to Conventional Wall Motion Analysis

Grigorios Korosoglou, Dirk Lossnitzer, Dieter Schellberg, Antje Lewien, Angela Wochele, Tim Schaeufele, Mirja Neizel, Henning Steen, Evangelos Giannitsis, Hugo A. Katus, and Nael F. Osman
Circ Cardiovasc Imaging 2009 2: 132-140. [Abstract] [Full Text] [PDF]