CCTA-derived strain analysis in detection of regional myocardial dysfunction in coronary artery disease patients with preserved left ventricular ejection fraction: A feasibility study

Abstract

OBJECTIVES: To evaluate the feasibility of using coronary computed tomography angiography (CCTA)-derived strain to detect regional myocardial dysfunction in coronary artery disease (CAD) patients with normal left ventricular ejection fraction (LVEF). METHODS: A total of 1,580 segments from 101 patients who underwent stressed CT myocardial perfusion imaging (CT-MPI) and CCTA were retrospectively enrolled in this study. The CT-derived global and segmental strain values were evaluated using the feature tracking technique. Segments with myocardial blood flow (MBF) < 125 ml/min/100 ml and 95 ml/min/100 ml were categorized as ischemic and infarcted, respectively. RESULTS: Segmental radial strain (SRS) and segmental circumferential strain (SCS) in the abnormal segments (including all segments with MBF < 125 ml/min/100 ml) were significantly lower than those in the normal segments (14.81±8.65% vs 17.17±9.13%, p < 0.001; –10.21±5.79% vs –11.86±4.52%, p < 0.001, respectively). SRS and SCS values in infarcted segments were significantly impaired compared with the ischemic segments (12.43±8.03% vs. 15.32±8.71%, p = 0.038; –7.72±5.91% vs. –10.67±5.66%, p = 0.010, respectively). The AUCs for SRS and SCS in detecting infarcted segments were 0.622 and 0.698, respectively (p < 0.05). CONCLUSIONS: It is feasible for using CCTA-derived strain parameters to detect regional myocardial dysfunction in CAD patients with preserved LVEF. Segmental radial and circumferential strain have the potential ability to distinguish myocardial ischemia from infarction, and normal from ischemic myocardium.