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Background <p>High-sensitivity troponin assays detect myocardial injury early, but only a subset reflects coronary plaque rupture requiring invasive therapy. Cardiovascular magnetic resonance (CMR) is the non-invasive reference standard for tissue characterization and functional assessment. Fast Strain-ENCoded imaging (fSENC) enables rapid strain analysis, and layer-specific strain may help identify ischemic causes.</p> Methods <p>In this prospective, single-centre observational study, patients presenting with chest pain and low-to-intermediate pretest probability for major adverse cardiac events (MACE) underwent rapid CMR prior to further therapy. Based on final clinical diagnosis, patients were classified as Healthy, acute coronary syndrome (ACS), or other cardiac abnormality (OCA). Global longitudinal strain (GLS) and the difference between endocardial and epicardial GLS (GLS-Dif) were quantified using fSENC. Follow-up assessed death and MACE.</p> Results <p>A total of 108 patients (50 female; age 57.5 ± 17.4&#xa0;years) were included. Total scanning time was 14 ± 3&#xa0;min. GLS was significantly reduced in ACS (− 17.1%) and OCA (− 15.8%) compared with Healthy patients (− 20.1%; both p &lt; 0.001), predicting any cardiac abnormality with an AUC of 86.5%. GLS-Dif was negative in ACS (− 0.6%) and significantly lower than in Healthy patients (1.5%) and OCA (0.95%), predicting ACS with an AUC of 91.3%. Combining GLS and GLS-Dif yielded excellent discrimination for cardiac abnormality (AUC 93.0%) and ACS (AUC 93.2%; sensitivity 100%; specificity 71.4%) and would have potentially reduced 35.3% of performed invasive coronary angiographies. Over a median follow-up &gt; 5&#xa0;years, death and MACE rates were low and unrelated to strain parameters.</p> Conclusions <p>Layer-specific CMR strain analysis using fSENC reliably identifies ischemic myocardial injury in suspected ACS, supporting clinical decision-making and potentially reducing unnecessary invasive procedures.</p> Graphical Abstract <p></p>

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Layer-specific fast strain-encoded cardiovascular magnetic resonance in suspected acute coronary syndrome: a prospective study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月20日

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  • Lukas D. Weberling,
  • Deborah Siry,
  • Ailís C. Haney,
  • Janek Salatzki,
  • Andreas Ochs,
  • Evangelos Giannitsis,
  • Norbert Frey,
  • Florian André

摘要

Background

High-sensitivity troponin assays detect myocardial injury early, but only a subset reflects coronary plaque rupture requiring invasive therapy. Cardiovascular magnetic resonance (CMR) is the non-invasive reference standard for tissue characterization and functional assessment. Fast Strain-ENCoded imaging (fSENC) enables rapid strain analysis, and layer-specific strain may help identify ischemic causes.

Methods

In this prospective, single-centre observational study, patients presenting with chest pain and low-to-intermediate pretest probability for major adverse cardiac events (MACE) underwent rapid CMR prior to further therapy. Based on final clinical diagnosis, patients were classified as Healthy, acute coronary syndrome (ACS), or other cardiac abnormality (OCA). Global longitudinal strain (GLS) and the difference between endocardial and epicardial GLS (GLS-Dif) were quantified using fSENC. Follow-up assessed death and MACE.

Results

A total of 108 patients (50 female; age 57.5 ± 17.4 years) were included. Total scanning time was 14 ± 3 min. GLS was significantly reduced in ACS (− 17.1%) and OCA (− 15.8%) compared with Healthy patients (− 20.1%; both p < 0.001), predicting any cardiac abnormality with an AUC of 86.5%. GLS-Dif was negative in ACS (− 0.6%) and significantly lower than in Healthy patients (1.5%) and OCA (0.95%), predicting ACS with an AUC of 91.3%. Combining GLS and GLS-Dif yielded excellent discrimination for cardiac abnormality (AUC 93.0%) and ACS (AUC 93.2%; sensitivity 100%; specificity 71.4%) and would have potentially reduced 35.3% of performed invasive coronary angiographies. Over a median follow-up > 5 years, death and MACE rates were low and unrelated to strain parameters.

Conclusions

Layer-specific CMR strain analysis using fSENC reliably identifies ischemic myocardial injury in suspected ACS, supporting clinical decision-making and potentially reducing unnecessary invasive procedures.

Graphical Abstract