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Kawakubo M, Nagao M, Yamamoto A, Kaimoto Y, Nakao R, Kawasaki H, Iwaguchi T, Inoue A, Kaneko K, Sakai A, Sakai S. Gated SPECT-Derived Myocardial Strain Estimated From Deep-Learning Image Translation Validated From N-13 Ammonia PET. Acad Radiol 2024:S1076-6332(24)00433-1. [PMID: 39095261 DOI: 10.1016/j.acra.2024.06.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/24/2024] [Accepted: 06/27/2024] [Indexed: 08/04/2024]
Abstract
RATIONALE AND OBJECTIVES This study investigated the use of deep learning-generated virtual positron emission tomography (PET)-like gated single-photon emission tomography (SPECTVP) for assessing myocardial strain, overcoming limitations of conventional SPECT. MATERIALS AND METHODS SPECT-to-PET translation models for short-axis, horizontal, and vertical long-axis planes were trained using image pairs from the same patients in stress (720 image pairs from 18 patients) and resting states (920 image pairs from 23 patients). Patients without ejection-fraction changes during SPECT and PET were selected for training. We independently analyzed circumferential strains from short-axis-gated SPECT, PET, and model-generated SPECTVP images using a feature-tracking algorithm. Longitudinal strains were similarly measured from horizontal and vertical long-axis images. Intraclass correlation coefficients (ICCs) were calculated with two-way random single-measure SPECT and SPECTVP (PET). ICCs (95% confidence intervals) were defined as excellent (≥0.75), good (0.60-0.74), moderate (0.40-0.59), or poor (≤0.39). RESULTS Moderate ICCs were observed for SPECT-derived stressed circumferential strains (0.56 [0.41-0.69]). Excellent ICCs were observed for SPECTVP-derived stressed circumferential strains (0.78 [0.68-0.85]). Excellent ICCs of stressed longitudinal strains from horizontal and vertical long axes, derived from SPECT and SPECTVP, were observed (0.83 [0.73-0.90], 0.91 [0.85-0.94]). CONCLUSION Deep-learning SPECT-to-PET transformation improves circumferential strain measurement accuracy using standard-gated SPECT. Furthermore, the possibility of applying longitudinal strain measurements via both PET and SPECTVP was demonstrated. This study provides preliminary evidence that SPECTVP obtained from standard-gated SPECT with postprocessing potentially adds clinical value through PET-equivalent myocardial strain analysis without increasing the patient burden.
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Affiliation(s)
- Masateru Kawakubo
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Michinobu Nagao
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan.
| | - Atsushi Yamamoto
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoko Kaimoto
- Department of Radiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Risako Nakao
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroshi Kawasaki
- Department of Advanced Information Technology, Faculty of Information Science and Electrical Engineering, Kyushu University, Fukuoka, Japan
| | - Takafumi Iwaguchi
- Department of Advanced Information Technology, Faculty of Information Science and Electrical Engineering, Kyushu University, Fukuoka, Japan
| | - Akihiro Inoue
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Koichiro Kaneko
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Akiko Sakai
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Shuji Sakai
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan
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Yamamoto A, Nagao M, Kawakubo M, Nakao R, Matsuo Y, Sakai A, Kaneko K, Fukushima K, Momose M, Sakai S, Yamaguchi J. Risk Stratification Using Right Ventricular Longitudinal Strain Ratio Derived from 13N-Ammonia PET in Patients with Ischemic Heart Disease. Radiol Cardiothorac Imaging 2024; 6:e230298. [PMID: 38814185 PMCID: PMC11211937 DOI: 10.1148/ryct.230298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 03/18/2024] [Accepted: 04/15/2024] [Indexed: 05/31/2024]
Abstract
Purpose To investigate whether right ventricular (RV) myocardial strain ratio (RVMSR) assessed using nitrogen 13 ammonia (13N-NH3) PET can predict cardiovascular events in patients with ischemic heart disease (IHD). Materials and Methods This retrospective study included 480 consecutive patients (mean age, 66 years ± 12 [SD]; 334 males and 146 females) with IHD who underwent 13N-NH3 PET. RVMSR was defined as the ratio of RV strain during stress to that at rest. The primary end point was major adverse cardiac events (MACEs), defined as cardiac death or heart failure hospitalization. The ability of RVMSR to predict MACE was assessed using receiver operating characteristic (ROC) curve and Kaplan-Meier analyses. Cox proportional hazards regression analysis was used to calculate hazard ratios (HRs) with 95% CIs. Results ROC curve analysis identified a sensitivity and specificity of 84% and 82%, respectively, for predicting MACE from RVMSR. Patients with reduced RVMSR (<110.2) displayed a significantly higher rate of MACE than those with a preserved RVMSR (34 of 240 vs four of 240; P < .001). Cox proportional hazards regression analysis of imaging parameters, including myocardial flow reserve, indicated that RVMSR was an independent predictor of MACE (HR, 0.94 [95% CI: 0.92, 0.97]; P < .001). Conclusion RVMSR was an independent predictor of MACE and has potential to aid in the risk stratification of patients with IHD. Keywords: Right Ventricular Myocardial Strain Ratio, Myocardial Flow Reserve, Ischemic Heart Disease, 13N-Ammonia Positron Emission Tomography Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Atsushi Yamamoto
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and
Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K.,
M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho,
Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of
Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of
Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
(K.F.)
| | - Michinobu Nagao
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and
Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K.,
M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho,
Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of
Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of
Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
(K.F.)
| | - Masateru Kawakubo
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and
Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K.,
M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho,
Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of
Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of
Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
(K.F.)
| | - Risako Nakao
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and
Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K.,
M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho,
Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of
Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of
Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
(K.F.)
| | - Yuka Matsuo
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and
Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K.,
M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho,
Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of
Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of
Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
(K.F.)
| | - Akiko Sakai
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and
Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K.,
M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho,
Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of
Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of
Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
(K.F.)
| | - Koichiro Kaneko
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and
Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K.,
M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho,
Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of
Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of
Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
(K.F.)
| | - Kenji Fukushima
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and
Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K.,
M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho,
Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of
Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of
Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
(K.F.)
| | - Mitsuru Momose
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and
Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K.,
M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho,
Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of
Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of
Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
(K.F.)
| | - Shuji Sakai
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and
Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K.,
M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho,
Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of
Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of
Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
(K.F.)
| | - Junichi Yamaguchi
- From the Department of Cardiology (A.Y., R.N., A.S., J.Y.) and
Department of Diagnostic Imaging and Nuclear Medicine (A.Y., M.N., Y.M., K.K.,
M.M., S.S.), Tokyo Women's Medical University, 8-1 Kawada-cho,
Shinjuku-ku, Tokyo, Japan 162-8666; Department of Health Sciences, Faculty of
Medical Sciences, Kyushu University, Fukuoka, Japan (M.K.); and Department of
Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
(K.F.)
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Sager DF, Manz N, Manser S, Laubscher L, Stark AW, Schütze J, Heiniger PS, Markendorf S, Kaufmann PA, Gräni C, Buechel RR. Reproducibility of Left Ventricular Function Derived From Cardiac Magnetic Resonance and Gated 13N-Ammonia Positron Emission Tomography Myocardial Perfusion Imaging: A Head-to-Head Comparison Using Hybrid Positron Emission Tomography/Magnetic Resonance. Acad Radiol 2024; 31:1248-1255. [PMID: 37940426 DOI: 10.1016/j.acra.2023.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 10/04/2023] [Accepted: 10/13/2023] [Indexed: 11/10/2023]
Abstract
RATIONALE AND OBJECTIVES Cardiac magnetic resonance (CMR) and gated 13N-ammonia positron emission tomography myocardial perfusion imaging (PET-MPI) offer accurate and highly comparable global left ventricular ejection fraction (LVEF) measurements. In addition to accuracy, however, reproducibility is crucial to avoid variations in LVEF assessment potentially negatively impacting treatment decisions. We performed a head-to-head comparison of the reproducibility of LVEF measurements derived from simultaneously acquired CMR and PET-MPI using different state-of-the-art commercially available software. MATERIALS AND METHODS 93 patients undergoing hybrid PET/MR were retrospectively included. LVEF was derived from CMR and PET-MPI at two separate core labs, using two state-of-the-art software packages for CMR (cvi42 and Medis Suite MR) and PET (QPET and CardIQ Physio). Intra- and inter-reader agreement was assessed using correlation and Bland-Altman (BA) analyses. RESULTS While intra- and inter-reader reproducibility of LVEF was high among both modalities and all software packages (r ≥ 0.87 and ICC≥0.91, all significant at p < 0.0001), LVEF derived from PET-MPI and analyzed with QPET outperformed all other analyses (intra-reader reproducibility: r = 0.99, ICC=0.99; inter-reader reproducibility: r = 0.98, ICC=1.00; Pearson correlations significantly higher than all others at p ≤ 0.0001). BA analyses showed smaller biases for LVEF derived from PET-MPI (-0.1% and +0.9% for intra-reader, -0.4% and -0.8% for inter-reader agreement) than those derived from CMR (+0.7% and +2.8% for intra-reader, -0.9% and -2.2% for inter-reader agreement) with similar results for BA limits of agreement. CONCLUSION Gated 13N-ammonia PET-MPI provides equivalent reproducibility of LVEF compared to CMR. It may offer a valid alternative to CMR for patients requiring LV functional assessment.
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Affiliation(s)
- Dominik F Sager
- Department of Nuclear Medicine, Cardiac Imaging , University Hospital of Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland (D.F.S., P.S.H., S.M., P.A.K., R.R.B.)
| | - Nico Manz
- Faculty of Medicine, University of Bern, Murtenstrasse 11, CH-3008 Bern, Switzerland (N.M., S.M.)
| | - Sarah Manser
- Faculty of Medicine, University of Bern, Murtenstrasse 11, CH-3008 Bern, Switzerland (N.M., S.M.)
| | - Lily Laubscher
- Department of Health Science and Technology, ETH Zurich, Ramistrasse 101, CH-8092 Zurich, Switzerland (L.L.)
| | - Anselm W Stark
- Department of Cardiology, University Hospital of Bern, Freiburgstrasse 15, CH-3010 Bern, Switzerland (A.W.S., J.S., C.G
| | - Jonathan Schütze
- Department of Cardiology, University Hospital of Bern, Freiburgstrasse 15, CH-3010 Bern, Switzerland (A.W.S., J.S., C.G
| | - Pascal S Heiniger
- Department of Nuclear Medicine, Cardiac Imaging , University Hospital of Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland (D.F.S., P.S.H., S.M., P.A.K., R.R.B.)
| | - Susanne Markendorf
- Department of Nuclear Medicine, Cardiac Imaging , University Hospital of Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland (D.F.S., P.S.H., S.M., P.A.K., R.R.B.)
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging , University Hospital of Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland (D.F.S., P.S.H., S.M., P.A.K., R.R.B.)
| | - Christoph Gräni
- Department of Cardiology, University Hospital of Bern, Freiburgstrasse 15, CH-3010 Bern, Switzerland (A.W.S., J.S., C.G
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging , University Hospital of Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland (D.F.S., P.S.H., S.M., P.A.K., R.R.B.).
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Nagao M, Kawakubo M, Yamamoto A, Nakao R, Matsuo Y, Fukushima K, Sakai A, Momose M, Sakai S. Myocardial Strain Derived from 13N-ammonia Positron Emission Tomography: Detection of Ischemia-Related Wall Motion Abnormality. ANNALS OF NUCLEAR CARDIOLOGY 2023; 9:26-32. [PMID: 38058577 PMCID: PMC10696145 DOI: 10.17996/anc.22-00161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 10/05/2022] [Accepted: 10/17/2022] [Indexed: 12/08/2023]
Abstract
Background: Due to the limitation of spatial resolution, cardiac nuclear medicine images have not been applied to feature-tracking method to automatic extraction of myocardial contours. We have successfully applied the feature-tracking method to high-resolution cine 13N-ammonia positron emission tomography (PET) images to calculate the regional myocardial strains. Here, we investigate the potential of 13N-ammonia PET-derived strain to detect ischemia-related wall motion abnormality. Methods: Data of adenosine-stress/rest 13N-ammonia PET for 95 coronary artery disease patients was retrospectively analyzed. Using an original algorithm dedicated to 13N-ammonia PET, the longitudinal strain (LS) corresponding to the three main coronary artery territories [right coronary artery (RCA), left anterior descending artery (LAD), and left circumflex coronary artery (LCX)] was calculated from semi-automatic endocardial contours extraction on cine 13N-ammonia PET images of the left ventricular long-axis. The presence of ischemia in three main territories was determined from rest and stress-perfusion images. Results: In all three coronary territories, LS at stress was significantly smaller at rest in the ischemic region RCA: -19.2±8.0% vs. -22.7±6.1%, LAD: -19.0±6.9% vs. -24.4±6.4%, LCX: -20.5%±7.6% vs. -22.6±6.9%). In contrast, in the non-ischemic region, there was no significant difference between the LS at stress and at rest. Receiver-operating-characteristic analysis revealed that using the optimal cutoff of the LS ratio of stress to rest, ischemia could be diagnosed with area under the curve of 0.82 in the RCA, 0.86 in the LAD, and 0.69 in the LCX. Conclusions: Myocardial strain derived from endocardial feature-tracking of 13N-ammonia PET cine imaging is reduced in the ischemia induced by adenosine-stress. The LS ratio of stress to rest may detect wall motion abnormality related to ischemia.
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Affiliation(s)
- Michinobu Nagao
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Masateru Kawakubo
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Atsushi Yamamoto
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Risako Nakao
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yuka Matsuo
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Kenji Fukushima
- Department of Nuclear Medicine, Fukushima Medical University, Fukushima, Japan
| | - Akiko Sakai
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Mitsuru Momose
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Shuji Sakai
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
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Huang J, Mitchell AJ, Garcia EV, Cooke CD, Folks R, Pernetz M, Goyal A, Piccinelli M, Nye JA. Left Ventricular Strain from Myocardial Perfusion PET Imaging: Method Development and Comparison to 2-Dimensional Echocardiography. J Nucl Med 2023; 64:932-939. [PMID: 36522185 PMCID: PMC10241013 DOI: 10.2967/jnumed.122.264516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 12/12/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
This study aimed to develop a measure of longitudinal, radial, and circumferential myocardial strain at rest and regadenoson during pharmacologic stress using 82Rb PET electrocardiography-gated myocardial perfusion imaging (MPI). Methods: We retrospectively identified 80 patients who underwent rest and regadenoson-stress CT attenuation-corrected 82Rb PET and had a standard resting transthoracic echocardiogram (TTE) with global longitudinal strain (GLS) analysis within 3 mo. A method was developed to compute longitudinal, radial, and circumferential strain from PET MPI at stress and rest. PET MPI-derived strain and left ventricular function were compared with resting TTE measures as the clinical reference standard. Interobserver agreement of PET MPI strain and left ventricular ejection fraction processing was reported. Results: Longitudinal strain assessed with resting TTE GLS showed good correlation with PET MPI at stress (r = 0.68, P < 0.001) and rest (r = 0.58, P < 0.001). Resting TTE GLS also correlated with PET MPI radial strain at stress (r = -0.70, P < 0.001) and rest (r = -0.59, P < 0.001) and circumferential strain at stress (r = 0.67, P < 0.001) and rest (r = 0.69, P < 0.001). The left ventricular ejection fraction showed good correlation between resting TTE and PET MPI at stress (r = 0.83, P < 0.001) and rest (r = 0.80, P < 0.001). Bland-Altman analysis indicated positive bias of TTE GLS compared with PET MPI longitudinal strain at stress (mean difference = 5.1%, 95% CI = [-2.5, 12.7]) and rest (mean difference = 4.2%, 95% CI = [-4.3, 12.8]). Reproducibility of PET MPI longitudinal strain showed good agreement at stress (concordance correlation coefficient = 0.73, P < 0.001) and rest (concordance correlation coefficient = 0.74, P < 0.001), with Bland-Altman analysis showing a small bias in the longitudinal direction at stress (mean difference = -0.2%) and rest (mean difference = -1.0%). Conclusion: Strain measured with PET MPI using an automated technique correlated well with resting GLS strain obtained by TTE, and the measure is reproducible. Strain from PET MPI should be investigated further to establish reference ranges and assess its value in routine clinical practice.
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Affiliation(s)
- Jingwen Huang
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Adam J Mitchell
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia;
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; and
| | - C David Cooke
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; and
| | - Russell Folks
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; and
| | - Maria Pernetz
- Emory Adult Congenital Heart Center, Emory University School of Medicine, Atlanta, Georgia
| | - Abhinav Goyal
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; and
| | - Jonathon A Nye
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; and
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