2024/05 - Layer-specific fast strain-encoded cardiac magnetic resonance imaging aids in the identification and discrimination of acute myocardial injury: a prospective proof-of-concept-May JCMR Journal Club 2024

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Video Summary

This JCMR Journal Club session featured a presentation on ultra-fast, layer-specific strain-encoded CMR (F-SENC) for evaluating acute myocardial injury in emergency patients with chest pain and elevated troponin. The study included 64 patients and 50 healthy controls, with CMR performed within 24 hours of symptom onset. Patients were categorized as NSTEMI, myocarditis, or other myocardial injury based on final clinical diagnosis.<br /><br />The main innovation was analyzing strain separately in the endocardial and epicardial layers. This layer-specific difference in global longitudinal strain helped distinguish NSTEMI, which tends to affect the subendocardium, from myocarditis, which more often involves the subepicardium. Global longitudinal strain and the number of dysfunctional segments were also useful for identifying myocardial injury overall, with very strong diagnostic performance when combined. Inter-observer and intra-observer reproducibility were excellent.<br /><br />The speakers emphasized that this very fast protocol could potentially reduce unnecessary invasive angiography, since many patients in the cohort underwent angiography but fewer than half ultimately needed revascularization. Current limitations include small sample size, lack of broad clinical reimbursement, and the fact that the method remains mainly research-based. The discussion also highlighted future applications in heart failure, cardiomyopathy, and cardio-oncology.

Keywords

ultra-fast CMR

F-SENC

acute myocardial injury

chest pain

troponin

layer-specific strain

NSTEMI

myocarditis

global longitudinal strain