Baessler, Bettina

Bunck, Alexander

Dick, Anastasia

Maintz, David

Michels, Guido

Quellhorst, Laura

Schaarschmidt, Frank

English

PubMed

Institutionelles Repositorium der Leibniz Universität Hannover

WORKSHOP PRESENTATION Open AccessCardiovascular magnetic resonance featuretracking derived strain parameters in patientswith acute myocarditis and preserved ejectionfraction: a validation studyBettina Baessler1*, Frank Schaarschmidt2, Laura Quellhorst1, Anastasia Dick1, Guido Michels3, David Maintz1,Alexander Bunck1From 19th Annual SCMR Scientific SessionsLos Angeles, CA, USA. 27-30 January 2016BackgroundThe purpose of this study was to validate the diagnosticvalue of cardiovascular magnetic resonance (CMR) fea-ture tracking (FT) derived strain parameters of bothventricles in patients with acute myocarditis (ACM) andpreserved left ventricular ejection fraction (EF).MethodsCMR data of 18 patients with clinically suspected ACMand confirmation of diagnosis by CMR according to theLake Louise criteria (LL criteria) were retrospectivelyanalyzed. 30 healthy volunteers (HV) served as a control.A second cohort consisting of 51 patients with clinicallydiagnosed ACM and preserved EF served as a validationcohort. All patients and HV were examined on a clinical1.5T scanner. Analysis of global longitudinal (long.), cir-cumferential (circ.) and radial strain and strain rate (SR)of both ventricles was performed in one long-axis andthree short-axis slices using a dedicated FT-software(TomTec Imaging Systems). Statistical analysis was con-ducted using independent t-test, one-way ANOVA withtukey-type comparisons, multinominal logistic regres-sion analyses, classification trees, and ROC-analyses.ResultsPatients with CMR-proven ACM and preserved EF (n =18) showed a significantly improved basal RV circ. SR com-pared to HV (-0.76 ± 0.05 vs. -0.47 ± 0.07 s-1, p = 0.005)while LV strain parameters showed no significant differ-ences between both groups. In multinominal logisticregression analyses, LV circ. strain and basal RV circ. SRproved to be the best independent predictors of ACMwhen LV-EF is preserved with an AUC of 0.82 in ROC-analysis. In classification trees, a cut-off of -29.0% for LVcirc. strain and of - 0.43 s-1 for basal RV circ. SR resultedin 80% sensitivity and 80% specificity for classificationbetween HV and CMR-proven ACM with preserved EF.Applying these cut-offs on the validation cohort (n =51) resulted in a moderate diagnostic sensitivity of 56%and a specificity of 71%. A re-estimation of logisticregression models in the validation cohort showed thata combination of LV long. strain and basal RV circ. SRwas superior in predicting ACM compared to the modelcontaining LV circ. strain. In classification trees, a cut-off of -20.4% for LV long. strain and of - 0.37 s-1 forbasal RV circ. SR resulted in 77% sensitivity and 80%specificity for classification between HV and ACM withpreserved EF.In ROC-analyses, the combination of LV long. strainand basal RV circ. SR showed superior diagnostic per-formance (AUC 0.82) when compared to LL criteria(AUC 0.76; Figure 1), and the combination of LV long.strain, basal RV circ. SR and Late Gadolinium Enhance-ment (LGE) further improved prediction of ACM withpreserved EF with an AUC of 0.87.ConclusionsThe proposed cut-off values for LV long. strain andbasal RV circ. SR show an additional diagnostic value to1Department of Radiology, University Hospital of Cologne, Cologne,GermanyFull list of author information is available at the end of the articleBaessler et al. Journal of Cardiovascular MagneticResonance 2016, 18(Suppl 1):W21http://www.jcmr-online.com/content/18/S1/W21© 2016 Baessler et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided theoriginal work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.the established Lake Louise criteria and may serve asnovel diagnostic parameters in the setting of ACM.Authors’ details1Department of Radiology, University Hospital of Cologne, Cologne,Germany. 2Institute of Biostatistics, Faculty of Natural Sciences, LeibnizUniversität Hannover, Hannover, Germany. 3Department III of Internalmedicine, Heart Center, University Hospital of Cologne, Cologne, Germany.Published: 27 January 2016doi:10.1186/1532-429X-18-S1-W21Cite this article as: Baessler et al.: Cardiovascular magnetic resonancefeature tracking derived strain parameters in patients with acutemyocarditis and preserved ejection fraction: a validation study. Journalof Cardiovascular Magnetic Resonance 2016 18(Suppl 1):W21.Submit your next manuscript to BioMed Centraland take full advantage of: • Convenient online submission• Thorough peer review• No space constraints or color figure charges• Immediate publication on acceptance• Inclusion in PubMed, CAS, Scopus and Google Scholar• Research which is freely available for redistributionSubmit your manuscript at www.biomedcentral.com/submitFigure 1 ROC-analysis for differentiating healthy volunteersfrom ACM patients in the validation cohort. Lake Louise Criteria(recorded as “present” or “not present”): Late Gadolinium Enhancement(LGE) + Visual edema on T2 black blood images + Early GadoliniumEnhancementBaessler et al. Journal of Cardiovascular MagneticResonance 2016, 18(Suppl 1):W21http://www.jcmr-online.com/content/18/S1/W21Page 2 of 2

Cardiovascular magnetic resonance feature tracking derived strain parameters in patients with acute myocarditis and preserved ejection fraction : A validation study

Bettina Baessler

Frank Schaarschmidt

Laura Quellhorst

Anastasia Dick

Guido Michels

David Maintz

Alexander Bunck

Springer - Publisher Connector

Cardiovascular magnetic resonance feature tracking derived strain parameters in patients with acute myocarditis and preserved ejection fraction: a validation study

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Cardiovascular magnetic resonance feature tracking derived strain parameters in patients with acute myocarditis and preserved ejection fraction : A validation study

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