(Circulation. 2000;101:981.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
From the Cardiology Division of the Department of Medicine (J.G., C.E.R., J.A.C.L.) and the Departments of Radiology (D.A.B., E.A.Z.) and Biomedical Engineering (E.R.M.) of the Johns Hopkins University School of Medicine, and the Department of Electrical and Computer Engineering of the Whiting School of Engineering (N.F.O., J.L.P.), Johns Hopkins University, Baltimore, Md.
Correspondence to João A.C. Lima, MD, Cardiology Division, Blalock 569, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-6568. E-mail jlima{at}welchlink.welch.jhu.edu
| Abstract |
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Methods and ResultsTagged MRI was performed in 10 volunteers at rest and during 5 to 20 µg-1 · kg-1 · min-1 dobutamine and in 9 postinfarct patients at rest. We compared 2D myocardial strains (circumferential shortening, Ecc; maximal shortening, E2; and E2, direction) as assessed by a conventional technique and by HARP. Full quantitative analysis of the data was 10 times faster with HARP. For pooled data, the regression coefficient was r=0.93 for each strain (P<0.001). In volunteers, Ecc and E2 were greater in the free wall than in the septum (P<0.01), but recruitable myocardial strain at peak dobutamine was greater in the LV septum (P<0.01). E2 orientation shifted away from the circumferential direction at peak dobutamine (P<0.01). HARP accurately detected subtle changes in myocardial strain fields under increasing doses of dobutamine. In patients, HARP-determined Ecc and E2 values were dramatically reduced in the asynergic segments as compared with remote (P<0.001), and E2 direction shifted away from the circumferential direction (P<0.001).
ConclusionsHARP MRI provides fast, accurate assessment of myocardial strains from tagged MR images in normal subjects and in patients with coronary artery disease with wall motion abnormalities. HARP correctly indexes dobutamine-induced changes in strains and has the potential for on-line quantitative monitoring of LV function during stress testing.
Key Words: magnetic resonance imaging ventricles myocardium contractility
| Introduction |
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SPAMM-tagged MR images correspond to a collection of spectral peaks in the Fourier domain.7 8 The inverse Fourier transform of one of these peaks is a complex image whose phase is linearly related to a directional component of the tissue displacement. A harmonic phase (HARP) image is the calculated phase of this complex image, which can be used to synthesize conventional tag lines and calculate 2D myocardial strain.14 This HARP imaging approach14 allows fast visualization and automated analysis of tagged cardiac MR images. Its potential in clinical cardiology depends on the demonstration of its sensitivity to small changes in myocardial strain during pharmacological stress testing and on its ability to accurately index regional wall motion abnormalities. We investigated the accuracy of HARP for quantitative assessment of 2D myocardial strain fields in normal individuals who underwent dobutamine stresstagged MRI and in postinfarct patients with underlying abnormal regional LV function.
| Methods |
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MRI Protocol
Images were acquired during multiple breath-holds on a 1.5-T
whole-body magnet (Signa, General Electric Medical Systems). Anterior
and posterior phased-array coils were used for signal acquisition. We
used an ECG-triggered segmented k-space fast gradient-echo imaging
pulse sequence.15 The tagging pulse sequence consisted of
nonselective radiofrequency pulses separated by spatial modulation of
magnetization-encoding gradients to achieve tag separation of 7
mm. After scout images were completed, contiguous stacks of 4
base-to-apex short-axis cross sections were prescribed. Two sets of
identical short-axis views were acquired (the second set rotated by
90°). A slab saturation band was applied to presaturate the blood in
the LV, resulting in "black blood" in the LV cavity. This imaging
sequence allowed us to image 4 slices within 4 breath-holds (
14 to
20 seconds each). The number of views per phase was decreased as heart
rate increased to maximize temporal resolution. Scanner settings were
field of view 36 cm, tag separation 7 mm, slice thickness 8
mm, TR 6.5 ms, TE 2.3 ms, tip angle 15°, and image matrix 256x160,
with 5 to 7 phase-encoded views per movie frame and cardiac cycle.
Dobutamine StressMR study
A single-lead ECG was continuously monitored and blood pressure
was recorded at baseline and every 3 minutes throughout the
procedure. After baseline acquisitions, dobutamine was
infused through a digital infusion pump at 5 and 20
µg-1 · kg-1
· min-1. Imaging began 2 minutes after each
dose increase and required 3 minutes for each of the 4 levels. Criteria
for terminating the study were (1) acceleration of heart rate >100%
of age-predicted maximal heart rate, (2) fall of systolic blood
pressure >30 mm Hg, (3) chest pain compatible with angina, (4)
frequent ventricular or supraventricular
ectopic beats, (5) intolerable side effects of
dobutamine.
Harmonic Phase Imaging
The SPAMM technique uses a special pulse sequence to spatially
modulate the longitudinal magnetization of the myocardium
before acquiring image data.7 8 SPAMM-tagged images have
regularly distributed spectral peaks in k-space, and each peak contains
information about tag motion in a given direction. HARP imaging is
based on the use of isolated peaks extracted with a bandpass filter
(Figure 1
) (Appendix A). One spectral
peak was extracted for each direction of tag lines.14 The
inverse Fourier transform of one of these peaks is a complex image
whose phase is linearly related to a directional component of the true
motion. The principal value of the phase was used to construct a HARP
image (Figure 1
) (Appendix A), which is linearly related to a
component of the 3D motion except that it is constrained to lie in the
range (-
,+
). Slopes of phases reflect the frequency of the tag
pattern and phase images reflect motion of the heart. HARP images can
be used to measure 2D strains14 16 (Appendix B), described
as normalized myocardial deformation in a specific direction given by a
unit vector. Figure 2
shows examples of
2D strain maps of the LV short-axis view throughout systole in a
healthy volunteer at 5 and 20 µg-1 ·
kg-1 · min-1
dobutamine.
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Strain Computation by Operator-Controlled Segmentation
Myocardial strains were assessed off-line by means of an
established technique11 and HARP by 2 independent
observers. Coordinates of the posterior right
ventricularLV insertion point were calculated on the most
basal slice and were used as reference landmarks for segmentation of
the LV. The myocardium was divided into 5 segments as
follows: segment 1, inferior; 2, inferolateral; 3, lateral;
4, anterior; and 5, septal wall. For the conventional analysis,
images were processed with the use of an in-housedeveloped software
program (Findtags). This method requires interactive and time-consuming
detection of myocardial contours and tag lines and generates a detailed
motion map through the use of interpolation.11 Detection
of myocardial contours or tag lines was not necessary with HARP. Strain
was defined as the deformation gradient and was related to the
derivative of the phase, that is, the local frequency. Eulerian strain
was calculated by means of the single-shot harmonic phase (SHARP)
approach.14 Three circles then were superimposed on the
first image from the subendocardium, throughout the
myocardium, to the subepicardium. The inner circle was
placed as close as possible to the endocardium while avoiding papillary
muscles. The outer circle was located as close as possible to the
epicardium and the mid-circle, equally spaced between the inner and
outer ones (Figure 3
). For a single
slice, 45 points (5 segmentsx3 layersx3 points per segment) were
automatically tracked throughout systole by the cine-HARP
approach.16 Strain changes were assessed between the
reference and the deformed state (end-systole) by the fractional
changes in length in the circumferential direction (Ecc) in each
myocardial layer. A negative value stands for compression of a line
segment between 2 material points. In addition, we calculated maximal
shortening (E2) as a principal strain given by
the magnitude as well as the direction of the associated
eigenvector.
|
Myocardial wall thickening (MWT) measured from cine-MR images was used
as a gold standard for the detection of regional wall motion
abnormality in patients with coronary artery disease (CAD). It
was calculated at baseline in postinfarct patients and volunteers
(control group), in the entire LV, by use of the automatic detection of
endocardial and epicardial boundaries (Findtags),11 as
![]() |
Statistical Analysis
Mean values are expressed as mean±SD. Comparisons between both
methods were assessed by linear regression analysis and
Bland-Altman plots. Mean values of myocardial strains in each
myocardial layer were compared by paired Students t test.
Comparisons of myocardial strains under different doses of
dobutamine were assessed by repeated-measures ANOVA.
Percent increase in strain under dobutamine was compared by
2 analysis. Interobserver
reproducibility of measurements by HARP was assessed in 4 randomly
selected volunteers and 4 patients by the use of a linear regression
analysis and by calculating the mean difference between both
series of measurements. All tests were 2-tailed, and a value of
P<0.05 was considered statistically significant.
| Results |
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10 hours by the conventional approach and 60 minutes by
HARP. For pooled data in normal and dysfunctional
myocardium, HARP led to reproducible results between 2
independent observers for Ecc, E2, and
E2 direction. Regression coefficients between
both analyses were r=0.98, 0.99, and 0.97,
respectively (P<0.0001). Mean differences between both
analyses were
5.4x10-4±3.5x10-3
(<2%),
1.8x10-3±9.6x10-3
(<2%), and 1.2±2.7° (<4%), respectively (NS).
For pooled data from volunteers and patients, the 2 methods
showed good correlation. For Ecc, E2, and
E2 direction, regression coefficients were
r=0.93 (P<0.001) (Figure 4
). Comparisons between data are
displayed in Bland-Altman plots in Figure 5
. In volunteers, the mean differences
between both techniques were
1.1x10-3±2.6x10-2
(0.5%, NS),
3.6x10-3±2.1x10-2
(1.6%, P<0.01), and 1.1±4.1° (7%, P<0.01),
for each strain, respectively. HARP led to a slight underestimation of
each myocardial strain in the subendocardium (-0.231±0.042 vs
-0.236±0.050, P=0.008, -0.256±0.049 vs -0.262±0.056,
P<0.0001, and 15.6±6.4 vs 17.3±6.6°,
P<0.0001, respectively). In patients with CAD, the mean
differences between both methods were also very small and statistically
not significant
(5.1x10-3±3.4x10-2,
4.1x10-3±3.5x10-2, and
0.2±6.2°, respectively).
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Myocardial Strain Changes Induced by Dobutamine
The mean time in the magnet was
30 minutes. We did not observe
any significant side effect during dobutamine infusion. The
evolution of 2D strains under dobutamine is displayed in
Figure 6
. For each strain, both
techniques were able to detect a transmural strain gradient.
Recruitable myocardial strain (%
increase at peak
dobutamine) as assessed by HARP increased similarly in
subendocardium and subepicardium (22.4% vs 21.6% for Ecc and 27.2%
vs 26.5% for E2, P=NS). The 2 methods
were able to depict subtle changes in myocardial strains during
dobutamine stimulation (5
µg-1 · kg-1
· min-1 vs baseline, P<0.01, and
20 vs 5 µg-1 ·
kg-1 · min-1,
P<0.001). E2 orientation shifted
further from the circumferential direction at 20
µg-1 · kg-1
· min-1 as compared with baseline (18±6° vs
12±5°, P<0.01) (Figure 6
). At baseline, Ecc and
E2 were greater in LV free wall (ie, lateral and
posterolateral wall) than in the septum (P<0.01)
(Table
). However, recruitable strain at peak
dobutamine was greater in LV septum than in free wall
(24.1% vs 14.6% and 27.6% vs 16.1%, for Ecc and
E2, respectively, P<0.01). At
baseline, Ecc and E2 were greater at the apex
compared with the base (P<0.01) (Table
), but
recruitable deformation was not significantly different at the apex
versus the base (21.2% vs 19.8% and 21.2% vs 19.7%, respectively,
NS).
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Myocardial Strain in Patients With CAD
Myocardial strain was measured in 9 patients (8 men, 43±11 years)
at baseline, 3±2 days after a first AMI (4 anterior, 5
inferior), and compared with MWT obtained from cine-MR
images. Of the 180 segments analyzed (5 segmentsx4 slicesx9
patients), 98 were classified as dysfunctional according to wall
thickening analysis (ie, MWT <2 SD). Of these, 46 were
classified as akinetic (MWT <5%). Figure 3
shows an example of
a strain map obtained by HARP in a patient with anterior AMI. In each
layer, Ecc and E2 were decreased in dysfunctional
myocardial segments when compared with remote (P<0.001) and
further decreased in akinetic segments (P<0.01 vs
dysfunctional) (Figure 7
).
E2 direction was increased in dysfunctional
segments when compared with remote (34±19 vs 19±10°, in the
subendocardium, P<0.001) and was further augmented in
akinetic segments (41±21°, P<0.01 vs dysfunctional).
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| Discussion |
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Dobutamine-Induced Myocardial Strain Alterations in the
Normal Human Heart
Previous studies using tagged MRI have reported normal
values and regional variations in 2D systolic strains at
rest.17 18 We compared myocardial deformation at 20
µg-1 · kg-1
· min-1 versus baseline and found a
significant increase in both circumferential and maximal shortening.
Other studies focusing on the effect of dobutamine on
regional LV function as assessed by tagged MRI in normal subjects have
shown an increase in myocardial strain from baseline to 10
µg-1 · kg-1
· min-1 and no dobutamine-induced
wall motion heterogeneity.19 20 Our data
confirm that dobutamine does not further exacerbate
variations in regional wall motion contractility
documented at rest. Although Ecc and E2 were less
in the anteroseptal than in the LV free wall at baseline, percent
increase in myocardial strain under dobutamine was greater
in the anteroseptal than in the free wall, resulting in a relative
homogeneity of myocardial contraction under inotropic stimulation. When
analyzed by cross-sectional level along the LV long axis,
dobutamine infusion resulted in a uniform increase in
myocardial strains, in agreement with recently reported
data.20
Because of wall shear (differences between subepicardial and
subendocardial rotational deformation), maximal shortening does not
occur in the same direction as circumferential shortening (Figure 8
). We report a slight increase in the
angle between Ecc and E2 orientations as a result
of dobutamine stimulation, indicating that
dobutamine slightly amplifies myocardial wall shear. In
agreement with previous studies,20 the angle remained
<20°, indicating that maximal shortening still remained
circumferentially oriented. Previous work has shown that
dobutamine leads to increased rotation of both
subepicardial and subendocardial layers in the normal left
ventricle.21 Because rotation increases in both layers,
changes in the direction of the eigenvector are blunted, maintaining LV
efficiency.
|
Potential Advantages of HARP
HARP can be used with any tagging technique provided the tag
pattern is planar and tag lines are uniformly apart from each other. We
assessed myocardial strain off-line from the tagged-image data set. We
defined the filter specifications for each series of images, which
represents the most time-consuming part before the HARP
analysis (30 to 40 minutes). Once the filter is set, a full
quantitative analysis of the data typically takes <3 minutes.
Standardized acquisitions of tagged images allow subsequent presetting
of the filter and can provide very fast myocardial strain mapping.
Furthermore, HARP images can be extracted directly from the raw data,
allowing very fast display of 2D strain fields. In other words, HARP
may provide on-line detailed quantitative assessment of 2D myocardial
strains.
Future Clinical Applications
HARP may have important clinical applications by overcoming the
main limitation to routine clinical utilization of tagged cardiac MRI.
When used in combination with dobutamine-tagged MRI, HARP
might be of great value for the detection of myocardial
ischemia during stress testing. Similarly, it might provide
fast and accurate quantification of functional recovery in stunned or
hibernating but viable myocardium.22 23 It
also might be useful for studying dynamic changes in regional LV
function after acute infarction by allowing serial quantitative
examinations over time.24 25 Alterations in LV torsional
deformation may be important in several pathological
states.26 Because HARP has the potential for other
applications of any tracking motion technique, it allows for rapid
noninvasive assessment of twist mechanics in the human heart, in
different myocardial segments, and at each myocardial layer.
Study Limitations
We measured 2D myocardial strain fields and did not
compensate for through-plane translation of the
heart.27 28 It is known that 3D deformation allows more
accurate evaluation of cardiac mechanics.29 However, 2D
analysis of regional myocardial function by tissue tagging is
sufficiently powerful surements of small planar displacements by HARP
are readily extendable to 3D motion by use of the out-of-plane tag
direction for quantitative assessment of a 3D strain
tensor.14 16
Conclusions
HARP MRI provides fast, accurate measurements of 2D strain
fields from tagged MR images in normal individuals and in patients with
wall motion abnormalities caused by CAD. It allows for detailed
analysis of the effect of graded dobutamine
stimulation on regional myocardial mechanics in the normal human LV.
Finally, with standardized acquisitions, HARP has the potential for
providing on-line quantitative monitoring of LV function during stress
testing in humans.
| Acknowledgments |
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| Appendix A |
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R2 represent the
coordinates of a point in the imaging plane. The intensity of this
point at time t is given by the scalar quantity I(y,
t). The tagged image can be written as
![]() |
![]() |
k as
![]() |
![]() |
k is the tag frequency vector of
the corresponding harmonic peak. The phase is related to the motion
according to the reference mapping function q(y, t) that
maps any point at (y, t) into its reference location
q when the tag pattern was imposed.
Wrapping Artifact
We obtained a wrapped version of the phase corresponding
to the harmonic phase image ak. HARP images
are related to the actual phase
k
![]() |
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| Appendix B |
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1 and
2.
The apparent strain in the direction e is given by
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R2x2=[
1
2] and
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Received July 28, 1999; revision received September 20, 1999; accepted October 6, 1999.
| References |
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