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Original article
Layer-specific analysis of myocardial function for accurate prediction of reversible ischaemic dysfunction in intermediate viability defined by contrast-enhanced MRI
  1. Michael Becker1,
  2. Ertunc Altiok1,
  3. Christina Lente2,
  4. Susanne Otten1,
  5. Zvi Friedman3,
  6. Dan Adam3,
  7. Renate Hoffmann1,
  8. Ralf Koos1,
  9. Gabriele Krombach4,
  10. Nikolaus Marx1,
  11. Rainer Hoffmann1
  1. 1Department of Cardiology, University Hospital RWTH Aachen, Aachen, Germany
  2. 2Department of Medical Statistics, University Hospital RWTH Aachen, Aachen, Germany
  3. 3Department of Biomedical Engineering, Technion Haifa, Haifa, Israel
  4. 4Department of Radiology, University Hospital RWTH Aachen, Aachen, Germany
  1. Correspondence to Professor Rainer Hoffmann, Medical Clinic I, University RWTH Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany; rhoffmann{at}


Background Contrast-enhanced MRI (ceMRI) has impaired accuracy in the prediction of functional recovery after revascularisation in cases of intermediate myocardial viability.

Objective To evaluate the predictive value of layer-specific myocardial deformation analysis for improvement in ischaemic dysfunction after revascularisation.

Methods In 132 patients with ischaemic left ventricular dysfunction undergoing revascularisation, myocardial viability was assessed by pixel-tracking-derived myocardial deformation imaging and ceMRI. Peak systolic circumferential strain was determined for total wall thickness and for three myocardial layers (endocardial, mid-myocardial and epicardial) in a 16-segment model. Analysis to predict recovery of function at 8±2 months after revascularisation was performed considering all dysfunctional segments or only segments with intermediate viability by ceMRI (hyperenhancement 25–75%, N=735 segments).

Results Segments with functional recovery (N=568) had higher circumferential strain in all myocardial layers and a smaller degree of hyperenhancement than segments without functional recovery (N=433). Analysis of all dysfunctional segments showed that the predictive accuracy for functional recovery was high for endocardial strain, total wall thickness strain and hyperenhancement by ceMRI (area under the curve (AUC) 0.883, 0.782 and 0.834, respectively). Considering only segments with intermediate viability by ceMRI, endocardial circumferential strain allowed prediction of functional recovery with higher accuracy (specificity 75%, sensitivity 78%, AUC=0.811, 95% CI 0.776 to 0.851) than hyperenhancement analysis (specificity 59%, sensitivity 72%, AUC=0.705, 95% CI 0.659 to 0.747, p<0.05).

Conclusion Analysis of layer-specific myocardial function using deformation imaging allows accurate identification of reversible myocardial dysfunction. In segments with intermediate viability analysis of layer-specific deformation may have special advantages for prediction of functional recovery.

Clinical trial registration information Identifier: NCT00476320.

  • Echocardiography
  • MRI
  • myocardial contraction
  • revascularisation
  • viability imaging
  • echocardiography-exercise
  • coronary artery disease (CAD)
  • myocardial viability

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  • This study was presented in part at the scientific sessions of the Americal College of Cardiology 2010.

  • Funding This study was supported by a research grant from the German–Israeli Foundation for Scientific Research and Development (GIF, I-873-77.10/2005).

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the University Aachen.

  • Provenance and peer review Not commissioned; externally peer reviewed.