2025/05 - Cardiovascular magnetic resonance radiologic-pathologic correlation in radiomic analysis of myocardium in non-ischemic dilated cardiomyopathy [Journal Club]-Cardiovascular magnetic resonance radiologic-pathologic correlation in radiomic analysis of myocardium in non-ischemic dilated cardiomyopathy

Cardiovascular magnetic resonance radiologic-pathologic correlation in radiomic analysis of myocardium in non-ischemic dilated cardiomyopathy

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Video Summary

This JCMR Journal Club session featured a presentation on a prospective proof-of-concept study of layer-specific fast strain-encoded CMR (F-SENC) for identifying acute myocardial injury. The study, led by a Heidelberg team, examined emergency department patients with chest pain or ischemic symptoms who were “ruled in” by high-sensitivity troponin testing. The goal was to determine whether ultra-fast CMR strain analysis could distinguish acute coronary syndrome/NSTEMI from myocarditis and other causes of myocardial injury, potentially reducing unnecessary invasive angiography.<br /><br />Using a single-heartbeat F-SENC protocol in three short-axis slices, the team analyzed global longitudinal strain, the number of dysfunctional segments, and a layer-specific metric comparing endocardial versus epicardial strain. Results showed strong diagnostic performance: global strain separated healthy controls from diseased patients, while the layer-specific difference in strain helped distinguish NSTEMI from myocarditis, reflecting their typical subendocardial versus subepicardial injury patterns. Adding dysfunctional segment counts improved performance further.<br /><br />The discussion focused on workflow, implementation, reproducibility, and reimbursement barriers. The speakers emphasized that the technique is fast, highly reproducible, and promising for chest-pain triage, though still mainly used in research. They also mentioned related applications in stress testing, cardiomyopathy, cardio-oncology, and heart failure.

Keywords

fast strain-encoded CMR

acute myocardial injury

NSTEMI

myocarditis

global longitudinal strain

layer-specific strain

emergency department chest pain

high-sensitivity troponin

myocardial injury diagnosis