Patient-Specific Cardiac Magnetic Resonance Feature Tracking Approach for Scar Detection in Concomitant Ischemic and Non-Ischemic Heart Disease

AIM: This study investigated a patient-specific approach of using cardiac magnetic resonance (CMR) feature tracking for scar detection in a heterogenous patient group with chronic ischemic and non-ischemic heart disease. METHODS: CMR exams of 89 patients with concomitant chronic ischemic and non-ischemic heart disease (IHD+) as well as 65 patients with ischemic scars only (IHD) were retrospectively evaluated. In all patients, global (GCS) and segmental circumferential strain (SCS) was derived from native cine images using a dedicated software (Segment CMR, Medviso). After calculation of patient-specific median GCS (GCS(median)), segmental values from GCS(median) percentage plots were correlated with corresponding myocardial segments in late gadolinium enhancement (LGE). RESULTS: Overall GCS ranged between −3.5% to −19.8% and average GCS was lower in IHD+ than in IHD (p <0.05). In IHD, 19% of all myocardial segments were infarcted, in IHD+ 16.6%. Additionally, non-ischemic LGE was present in 6.7% of segments in IHD+. Correlation of GCS(median) percentage plots with corresponding LGE showed that presence of ischemic scar tissue in a myocardial segment was very likely below a cut-off of 39.5% GCS(median) (87.5% sensitivity, 86.3% specificity, AUC 0.907, 95% CI 0.875-0.938, p < 0.05). CONCLUSION: In patient-specific GCS(median) percentage plots calculated from native cine images, ischemic scar tissue can be suspected in myocardial segments below the threshold of 40% GCS(median) (sensitivity 88%, specificity 86%), even in a heterogenous patient cohort with ischemic and non-ischemic heart disease.