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Quantitative circumferential strain analysis using ATP-stress/rest 3-Tesla tagged magnetic resonance to evaluate regional contractile dysfunction in ischemic heart disease


We evaluated whether quantitative circumferential strain (C-strain) analysis using adenosine triphosphate (ATP)-stress/rest 3-Tesla (3-T) tagged magnetic resonance (MR) can depict myocardial ischemia as contractile dysfunction on stress. We evaluated whether it can differentiate non-ischemia, myocardial ischemia and infarction. We assessed its diagnostic performance in comparison with ATP-stress myocardial perfusion MR and late gadolinium enhancement (LGE)-MR.


In 38 patients suspected of having coronary artery disease (CAD), tagged MR and perfusion MR under ATP-stress and rest conditions and LGE-MR imaging were performed. The peak negative value (%) of the circumferential strain (C-strain) during a cardiac cycle and the time-to-peak C-strain were measured in the left ventricle using short-axis tagged images during ATP-stress and at-rest conditions. Myocardial segments were categorized as non-ischemic (n = 485), ischemic (n = 74), or infarcted (n = 49) from the results of perfusion MR and LGE-MR.


In non-ischemic segments, C-strain was significantly greater during ATP-stress (-15.9 ± 3.1%) (mean ± SD) than at-rest (-14.0 ± 3.2%, p < 0.001) imaging. Conversely, in ischemic segments, C-strain was significantly lower during ATP-stress (-13.9 ± 3.2%) than at-rest (-15.4 ± 3.1%, p < 0.01) imaging.

Under both ATP-stress and at-rest conditions, C-strain values in infarcted segments were significantly lower than those in non-ischemic and ischemic segments. Under ATP-stress, C-strain in non-ischemic segments was significantly greater than that in ischemic segments. However, under at-rest conditions, there was no significant difference between ischemic and non-ischemic segments.

Cutoff values of -12.0% for at-rest C-strain and 49.4% for at-rest time-to-peak C-strain allowed differentiation between infarcted segments from non-ischemic and ischemic segments with sensitivities of 79% and 61%, specificities of 76% and 91%, accuracies of 76% and 88%, and areas under the curve (AUCs) of 0.81 and 0.75, respectively. The differences in C-strain values between ATP-stress and at-rest conditions (stress−rest C-strain) in non-ischemic segments (−1.78 ± 2.45%) were significantly smaller than in segments with ischemia (+1.47 ± 1.89%, p < 0.001). A cutoff value of +0.3% for the stress−rest C-strain value could differentiate segments with ischemia from non-ischemic segments with a sensitivity of 75%, a specificity of 82%, an accuracy of 82%, and an AUC of 0.86.


C-strain analysis using tagged MR can quantitatively assess contractile dysfunction in ischemic and infarcted myocardium.



Figure 1
figure 1

A, anterior; AS, anteroseptal; IS, inferoseptal; I, inferior; IL, inferolateral; AL, anterolateral

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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Nakamura, M., Kido, T. & Mochizuki, T. Quantitative circumferential strain analysis using ATP-stress/rest 3-Tesla tagged magnetic resonance to evaluate regional contractile dysfunction in ischemic heart disease. J Cardiovasc Magn Reson 17 (Suppl 1), Q64 (2015).

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