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Myocardial extracellular volume fraction radiomics analysis for differentiation of reversible versus irreversible myocardial damage and prediction of left ventricular adverse remodeling after ST-elevation myocardial infarction

  • Cardiac
  • Published:
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Abstract

Objectives

Our study sought to explore the prognostic value of radiomic TA (texture analysis) on quantitative ECV (extracellular volume) fraction mapping to differentiate between reversible and irreversible myocardial damage and to predict left ventricular adverse remodeling in patients with reperfused STEMI (ST-elevation myocardial infarction).

Methods

This observational prospective cohort study identified 70 patients (62 ± 9 years, 62 men [85.70%]) with STEMI for TA who consecutively performed native and contrast T1 mapping. Texture features were extracted from each stack of ECV mapping based on ROI (region of interest) analysis.

Results

After texture feature selection and dimension reduction, five selected texture features were found to be statistically significant for differentiating the extent of myocardial injury. ROC (receiver operating characteristic) curve analysis for the differentiation of unsalvageable infarction and salvageable myocardium demonstrated a significantly higher AUC (area under the curve) (0.91 [95% CI, 0.86–0.96], p < 0.0001) for horizontal fraction than other texture features (p < 0.05). LVAR (left ventricular adverse remodeling) was predicted by those selected features. The differences in qualitative and quantitative baseline parameters and horizontal fractions were significant between the patients with and without LVAR. LGE (late gadolinium enhancement) and horizontal fraction features of infarcted myocardium in acute STEMI were the only two parameters selected in forming the optimal overall multivariable model for LVAR at 6 months.

Conclusions

Radiomic analysis of ECV could discriminate reversible from irreversible myocardial injury after STEMI. LGE as well as radiomics TA (texture analysis) of ECV may provide an alternative to predict LVAR and functional recovery.

Key Points

• ECV quantification was able to differentiate between infarcted myocardium and non-infarcted myocardium.

• Radiomics analysis of ECV could discriminate reversible from irreversible myocardial injury.

• Radiomics TA analysis shows a promising similarity with LGE findings which could aid the prognosis of myocardial infarction patients.

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Abbreviations

AAR:

Area at risk

AUC:

Areas under the receiver-operating characteristic curves

BNP:

Brain natriuretic peptide

CMR:

Cardiac magnetic resonance

ECV:

Extracellular volume

Gd-DTPA:

Diethylenetriaminepentacetate

ICC:

Intraclass correlation coefficients

IMH:

Intramyocardial hemorrhage

LGE:

Late gadolinium enhancement

LVAR:

Left ventricular adverse remodeling

LVEDV:

Left ventricular end-diastolic volume

LVEF:

Left ventricular ejection fraction

LVESV:

Left ventricular end-systolic volume

MOLLI:

Modified look-locker inversion

MRI:

Magnetic resonance imaging

MVO:

Microvascular obstruction

PCI:

Percutaneous coronary intervention

ROC:

Receiver operating characteristic

ROC:

Receiver operation characteristic

SSFP:

Steady-state free-precession

STEMI:

ST-elevation myocardial infarction

T2WI-STIR:

T2-weighted short-tau triple inversion recovery

TA:

Texture analysis

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Funding

This study is supported by the National Natural Science Foundation of China (No. 81873886 and No. 81873887); Shanghai Municipal Commission of Health and Family Planning Excellent Young Talent Program (No. 2017YQ031); Shanghai Shenkang Hospital Development Center Clinical Research and Cultivation Project (SHDC12018X21); Shanghai Science and Technology Innovation Action Plan, Technology Standard Project (19DZ2203800); Shanghai Jiao Tong University School of Medicine Double Hundred Outstanding Person Project (20191904); and Shanghai Jiao Tong University Medical Cross Project YG2017QN44.

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Author notes

  1. Bing-Hua Chen and Dong-Aolei An contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 PuJian Road, Shanghai, 200127, People’s Republic of China

    Bing-Hua Chen, Dong-Aolei An, Chong-Wen Wu, Ting Yue, Rui Wu, Ruo-Yang Shi, Jian-Rong Xu & Lian-Ming Wu

  2. Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 PuJian Road, Shanghai, 200127, People’s Republic of China

    Jie He & Jun Pu

  3. Department of Radiology, Wayne State University, Detroit, MI, 48201, USA

    Khalid Eteer, Bobby Joseph & Jiani Hu

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  1. Bing-Hua Chen
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Corresponding authors

Correspondence to Jian-Rong Xu, Lian-Ming Wu or Jun Pu.

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Guarantor

The scientific guarantor of this publication is Lian-ming Wu.

Conflict of interest

The authors state that there neither exists a conflict of interest nor that there is financial information to disclose.

Statistics and biometry

Lian-ming Wu kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was obtained from all participants in this study.

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Institutional Review Board approval was obtained.

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• prospective

• observational

• single-center study

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Chen, BH., An, DA., He, J. et al. Myocardial extracellular volume fraction radiomics analysis for differentiation of reversible versus irreversible myocardial damage and prediction of left ventricular adverse remodeling after ST-elevation myocardial infarction. Eur Radiol 31, 504–514 (2021). https://doi.org/10.1007/s00330-020-07117-9

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  • DOI: https://doi.org/10.1007/s00330-020-07117-9

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