Prediction of functional recovery by cardiac magnetic resonance feature tracking imaging in first time ST-elevation myocardial infarction. Comparison to infarct size and transmurality by late gadolinium enhancement

Int J Cardiol. 2015 Mar 15;183:162-70. doi: 10.1016/j.ijcard.2015.01.022. Epub 2015 Jan 7.


Purpose: To investigate whether myocardial deformation imaging, assessed by feature tracking cardiac magnetic resonance (FTI-CMR), would allow objective quantification of myocardial strain and estimation of functional recovery in patients with first time ST-elevation myocardial infarction (STEMI).

Methods: Cardiac magnetic resonance (CMR) imaging was performed in 74 consecutive patients 2-4 days after successfully reperfused STEMI, using a 1.5T CMR scanner (Philips Achieva). Peak systolic circumferential and longitudinal strains were measured using the FTI applied to SSFP cine sequences and were compared to infarct size, determined by late gadolinium enhancement (LGE). Follow-up CMR at 6 months was performed in order to assess residual ejection fraction, which deemed as the reference standard for the estimation of functional recovery.

Results: During the follow-up period 53 of 74 (72%) patients exhibited preserved residual ejection fraction ≥50%. A cut-off value of -19.3% for global circumferential strain identified patients with preserved ejection fraction ≥50% at follow-up with sensitivity of 76% and specificity of 85% (AUC=0.86, 95% CI=0.75-0.93, p<0.001), which was superior to that provided by longitudinal strain (ΔAUC=0.13, SE=0.05, z-statistic=2.5, p=0.01), and non-inferior to that provided by LGE (ΔAUC=0.07, p=NS). Multivariate analysis showed that global circumferential strain and LGE exhibited independent value for the prediction of preserved LV-function, surpassing that provided by age, diabetes and baseline ejection fraction (HR=1.4, 95% CI=1.0-1.9 and HR=1.4, 95% CI=1.1-1.7, respectively, p<0.05 for both).

Conclusions: Estimation of circumferential strain by FTI provides objective assessment of infarct size without the need for contrast agent administration and estimation of functional recovery with non-inferior accuracy compared to that provided by LGE.

Keywords: Cardiac magnetic resonance; FTI; Late gadolinium enhancement; Left ventricular function; Myocardial infarction; STEMI; Two dimensional strain imaging.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Contrast Media
  • Electrocardiography / methods
  • Female
  • Gadolinium
  • Humans
  • Image Enhancement / methods*
  • Image Interpretation, Computer-Assisted
  • Magnetic Resonance Imaging, Cine / methods*
  • Male
  • Middle Aged
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / physiopathology*
  • ROC Curve
  • Recovery of Function
  • Sensitivity and Specificity
  • Stroke Volume / physiology
  • Troponin T / analysis
  • Ventricular Function, Left / physiology


  • Contrast Media
  • Troponin T
  • Gadolinium