Fast strain-encoded imaging (fSENC)-MRI can detect fractional length changes of myocardial fibrils between end-systole and end-diastole within a very short time. However, to date, this procedure has not been used in patients with acute chest pain. Now study results demonstrated a high diagnostic value of this non-invasive method.
Acute coronary syndrome is diagnosed according to guidelines on the basis of clinical symptoms, ECG, and biomarker determination. However, 15% of all affected persons cannot be reliably clarified after one hour. You need further tests. One advantage of fSENC MRI is the fast acquisition time. Within a single heartbeat, recordings of the entire cycle can be generated. In addition, no drugs, contrast agents or complex post-processing are required. However, this procedure has not yet been tested in the acute setting.
Therefore, the aim of a prospective study was to evaluate fSENC in patients with acute chest pain presenting to the Chest Pain Unit regarding a correct rule-in/out of an ischemic cause. Patients in whom an acute ischemic cause could be identified or ruled out should be identified, as well as those who had other cardiac pathology. A unique feature of the study was that a hyperventilation maneuver was used as a noninvasive stress test. This can achieve greater vasodilation than intravenous administration of adenosine.
High additional information gain
A total of 108 patients with chest pain and a hscTnT level requiring control were recruited. The fSENC MRI was performed before the second hscTnT measurement. Patients were asked to hyperventilate for one minute and then hold their breath briefly. Meanwhile, the recordings were generated. In 86 patients, acute ischemic events could be excluded in this way, and in 17 the cause of the pain was diagnosed as ischemic. Especially within the observation zone, fSENC-MRI provided a high information gain in addition to the serial hscTnT measurement. Furthermore, the diagnostic significance could be further increased by the hyperventilation maneuver. A significant superiority of the hit rate was shown for combination of rest and stress recordings. The authors are confident that fSENC is safe to use in the acute setting and allows objective quantification of wall motion abnormalities.
Source: DGK Heart Days
Further reading:
- Siry D, Salatzki J, André F, et al: fSENC – a novel approach to analyzing myocardial deformation in patients with acute chest pain. Clin Res Cariol 2019; P313. DOI: https://doi.org/10.1007/s00392-019-01534-7
CARDIOVASC 2019; 18(6): 34 (published 5/12/19, ahead of print).
