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Updated: Nov 21, 2025
Magnetic Resonance Derived Myocardial Strain Assessment Using Feature Tracking
Published on: February 12, 2011
Fast Strain-Encoded Cardiac Magnetic Resonance for Diagnostic Classification and Risk Stratification of Heart Failure
Grigorios Korosoglou1, Sorin Giusca1, Moritz Montenbruck2
1Departments of Cardiology, Vascular Medicine and Pneumology, GRN Hospital Weinheim, Weinheim, Germany.
Insights
Fast-strain encoded magnetic resonance (% normal myocardium) better classifies heart failure stages and identifies subclinical dysfunction than ejection fraction. This improves risk stratification for asymptomatic patients, potentially impacting medical outcomes.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Medical Diagnostics
Background:
- Heart failure is a significant cause of global morbidity and mortality.
- Accurate classification and risk stratification are crucial for managing heart failure patients.
Purpose of the Study:
- To evaluate the efficacy of fast-strain encoded magnetic resonance (fast-SENC) cardiac magnetic resonance (CMR) in classifying and risk-stratifying heart failure patients.
- To compare fast-SENC's performance against standard clinical and CMR data, including LV ejection fraction.
Main Methods:
- 1,169 consecutive patients and 61 healthy volunteers underwent CMR.
- Left ventricular (LV) ejection fraction, global strain, and % normal myocardium (derived from fast-SENC) were calculated.
- Clinical follow-up was conducted for Stages A and B heart failure patients.
Main Results:
- % Normal myocardium, LV ejection fraction, and global strain decreased significantly with increasing heart failure stages (p < 0.001).
- % Normal myocardium was a stronger independent predictor of heart failure stage than LV ejection fraction (r=0.76 vs. r=0.30).
- 37% of Stage A patients were reclassified to Stage B, showing subclinical LV dysfunction and higher mortality/hospitalization rates.
Conclusions:
- Fast-SENC derived % normal myocardium improves identification of subclinical LV dysfunction in asymptomatic patients.
- This metric offers superior risk stratification for early-stage heart failure compared to LV ejection fraction.
- Identifying high-risk asymptomatic individuals has significant implications for proactive heart failure management.
Objectives:
The purpose of this study was to compare the ability of fast-strain encoded magnetic resonance (fast-SENC) cardiac magnetic resonance (CMR) to classify and risk stratify all-comer patients with different stages of chronic heart failure (Stages of heart failure A to D) based on American College of Cardiology/American Heart Association guidelines with standard clinical and CMR imaging data.
Background:
Heart failure is a major cause of morbidity and mortality, resulting in millions of deaths and hospitalizations annually.
Methods:
The study population consisted of 1,169 consecutive patients between September 2017 and February 2019 who underwent CMR for clinical reasons, and 61 healthy volunteers. In addition, clinical follow-up was performed in Stages A and B patients after 1.9 ± 0.4 years. Wall motion score and late gadolinium enhancement score indexes, left ventricular (LV) ejection fraction, and global circumferential and longitudinal strain based on fast-SENC acquisitions, were calculated in all subjects. The percentage of myocardial segments with strain ≤-17% (% normal myocardium) was determined in all subjects.
Results:
LV ejection fraction, global circumferential and longitudinal strain, and % normal myocardium significantly decreased with increasing heart failure stages (p < 0.001 for all by analysis of variance). By multivariable analysis, % normal myocardium remained an independent predictor of heart failure stages, exhibiting closer association than LV ejection fraction (rpartial = 0.76 vs. rpartial = 0.30; p < 0.001). Importantly, 149 of 399 (37%) with Stage A were reclassified to Stage B, that is, as having subclinical LV dysfunction based on % normal myocardium <80%. Such patients exhibited significantly higher rates of all-cause mortality and hospital stay due to heart failure during follow-up, compared with patients with % normal myocardium ≥80% (chi-square = 6.9; p = 0.03).
Conclusions:
The % normal myocardium, determined by fast-SENC, enables improved identification of asymptomatic patients with subclinical LV dysfunction compared with LV ejection fraction and risk stratification of patients with so far asymptomatic heart failure. The identification of such presumably healthy patients at high risk for heart failure-related outcomes may bear important medical implications.
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