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Myocardial area at risk and salvage in reperfused acute MI measured by texture analysis of cardiac T2 mapping and its prediction value of functional recovery in the convalescent stage

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Abstract

Objectives

We sought to distinguish area at risk from salvage myocardial zone and to predict left ventricle functional recovery in the convalescent stage by Texture Analysis (TA) of T2−Mapping.

Methods

One hundred and six patients diagnosed with AMI and treated with percutaneous coronary intervention (PCI) underwent acute cardiac magnetic resonance imaging (CMR) and 45 of whom had a subsequent CMR scan following recovery. Cine imaging, T2−Mapping, T2−weighted STIR imaging, and LGE imaging were performed. In the texture analysis, regions of interest (infarcted, salvageable, and remote) were drawn by two blinded, independent readers.

Results

Seven independent texture features on T2−Mapping were selected: Perc.50%, S(2,2)InvDfMom, S(2.−2)AngScMom, S(4,0)Entropy, 45dgrLngREmph, 45dgr_Fraction and 135dr_GLevNonU. Among them, the average value of 135dr_GLevNonU in the infarct zone, AAR zone, and the remote zone was: 61.96±26.03, 31.811±18.933 and 99.839±26.231, respectively. Additionally, 135dr_GLevNonU provided the highest area under the curve (AUC) from the receiver operating characteristic curve (ROC curve) for distinguishing AAR from the infarct zone in each subgroup (all patients, patients with MVO and)were 0.845 ± 0.052 0.855 ± 0.083 and 0.845 ± 0.066, respectively, and were more promise than T2−Mapping mean (p<0.001). The AUC for differentiating AAR from the remote zone is 0.942±0.041. Texture features are not associated with convalescent decreased strain, ejection fraction (EF) or left ventricle remodeling (LVR) in analysis (p>0.05).

Conclusion

TA of T2−mapping can distinguish AAR from both the infarct zone and the remote myocardial zone without LGE imaging in reperfused AMI. However, these features are not able to predict patients’ functional recovery in the convalescent stage.

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Abbreviations

TA:

Texture analysis

AAR:

Area at risk

PCI:

Percutaneous coronary intervention

CMR:

Cardiac magnetic resonance imaging

AMI:

Myocardial infarction

AMI:

Acute myocardial infarction

T2W-STIR:

T2-weighted short-tau triple inversion recovery

LGE:

Late gadolinium enhancement

AUC:

Area under the curve

ROC curve:

Receiver operating characteristic curve

MVO:

Microvascular obstruction

IMH:

Intramyocardial hemorrhage

EF:

Ejection fraction

LVR:

Left ventricle remodeling

ACS:

Acute coronary syndrome

CKD:

Chronic kidney diseases

FIS:

Final infarct size

FWHM:

Full width at half maximum

EDV:

End-diastolic volume

ESV:

End-systolic volume

SAX:

Short axis

ICC:

Intraclass correlation coefficient

ROI:

Region of interest

SSFP:

Steady-state free precession

HD:

Hemodialysis

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Acknowledgements

We acknowledge the assistance from Rui Wu, Ruo-yang Shi and Yi-si Dai, who provided a lot of help in data processing.

Funding

Supported by National Natural Science Foundation of China (No.81873886 and No.81873887), Shanghai Shenkang Hospital Development Center Clinical Research and Cultivation Project (SHDC12018X21); Shanghai Science and technology innovation action plan, technology standard project (19DZ2203800); Shanghai Jiao Tong University school of medicine Double hundred outstanding person projrect (20191904); Shanghai Jiao Tong University medical cross project YG2017QN44.

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Author notes

  1. Zi-Yang Fan, Chong-wen Wu and Dong-Aolei An have contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China

    Zi-Yang Fan, Chong-wen Wu, Dong-Aolei An, Bing-Hua Chen, Jian-rong Xu, Yan Zhou & Lian-Ming Wu

  2. Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China

    Jie He & Jun Bu

  3. Department of Radiology, School of Medicine, Wayne State University, Detroit, MI, 48201, USA

    Luke D. Wesemann & Jia-ni Hu

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  1. Zi-Yang Fan
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Correspondence to Jian-rong Xu, Yan Zhou or Lian-Ming Wu.

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Supplementary Information

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10554_2021_2336_MOESM1_ESM.tif

Supplementary file1 (TIF 6397 kb) Receiver operating characteristic (ROC) analyses for participants in differentiating infarcted and salvageable myocardium in all acute patients (a), patients without MVO (b) and patients with MVO (c).The ROC value for (a) is: Mean,0.647±0.074; Perc.500.639±0.074; (2,2)InvDfMom0.585±0.077; (2,-2)AngScMom0.647±0.074; (4,0)Entropy0.759±0.074; 45dgrLngREmph0.791±0.061; 45dgr_Fraction0.772±0.064;135dr_GLevNonU0.845±0.052.

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Fan, ZY., Wu, Cw., An, DA. et al. Myocardial area at risk and salvage in reperfused acute MI measured by texture analysis of cardiac T2 mapping and its prediction value of functional recovery in the convalescent stage. Int J Cardiovasc Imaging 37, 3549–3560 (2021). https://doi.org/10.1007/s10554-021-02336-7

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