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Magnetic Resonance Derived Myocardial Strain Assessment Using Feature Tracking
Published on: February 12, 2011
Left Ventricular Strain Is Abnormal in Preclinical and Overt Hypertrophic Cardiomyopathy: Cardiac MR Feature Tracking
Davis M Vigneault1, Eunice Yang1, Patrick J Jensen1
1From the Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md (D.M.V., M.W.T.); Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, England (D.M.V., M.W.T., J.A.N.); Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, Mass (D.M.V.); Division of Cardiology (E.Y.) and Russell H. Morgan Department of Radiology and Radiological Science (L.C.), Johns Hopkins Hospital, Baltimore, Md; University of Chicago, The College, Chicago, Ill (P.J.J.); Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio (M.W.T.); Cardiovascular Division, Brigham and Women's Hospital, Boston, Mass (H.F., C.Y.H.); Departments of Internal Medicine and Pediatrics, University of Michigan, Ann Arbor, Mich (S.M.D., M.W.R.); Department of Cardiology, Boston Children's Hospital, Boston, Mass (S.D.C.); The Heart Institute and Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.T.);New York University Langone Medical Center, New York, NY (M.V.S.); Department of Pediatrics, Washington University School of Medicine, St Louis, Mo (C.E.C.); Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Mass (L.S.); and School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI 53792 (D.A.B.).
Insights
Cardiac MRI feature tracking reveals myocardial dysfunction in hypertrophic cardiomyopathy (HCM) patients, even before left ventricular hypertrophy develops. This finding highlights early contractile abnormalities in sarcomere mutation carriers.
Area of Science:
- Cardiology
- Medical Imaging
- Genetics
Background:
- Left ventricular (LV) dysfunction can signal early disease in preclinical hypertrophic cardiomyopathy (HCM), particularly in sarcomere mutation carriers without LV hypertrophy.
- Cardiac Magnetic Resonance Imaging (CMR) feature tracking offers a method to assess myocardial strain in individuals with HCM sarcomere mutations.
Purpose of the Study:
- To evaluate myocardial strain and circumferential transmural strain difference (cTSD) in a genotyped cohort with HCM.
- To explore correlations between cTSD and other markers of disease severity, including anatomical and functional parameters.
Main Methods:
- A prospective, multicenter, observational study (HCMNet) enrolled participants with HCM and their family members, all undergoing genetic testing.
- Cardiac MRI with high temporal resolution (≤40 msec) was performed, and LV myocardial strain was analyzed using feature-tracking software.
- Circumferential strain was measured at epicardial and endocardial surfaces to calculate cTSD. Multivariable logistic regression was used to predict HCM status.
Main Results:
- Ninety-nine participants were analyzed: 23 controls, 34 with preclinical HCM, and 42 with overt HCM.
- cTSD was significantly higher in both preclinical (17% ± 4) and overt HCM (22% ± 7) groups compared to controls (14% ± 4) (P < .01 for all).
- In multivariable models, cTSD independently predicted preclinical and overt HCM status (P < .01), even after adjusting for septal thickness and N-terminal brain-type natriuretic peptide levels.
Conclusions:
- Cardiac MRI feature tracking effectively identifies myocardial dysfunction in overt HCM.
- This technique also detects dysfunction in sarcomere mutation carriers without LV hypertrophy, indicating early contractile abnormalities.
- Myocardial dysfunction is present in HCM carriers even with normal LV wall thickness.
Abstract:
Purpose To evaluate myocardial strain and circumferential transmural strain difference (cTSD; the difference between epicardial and endocardial circumferential strain) in a genotyped cohort with hypertrophic cardiomyopathy (HCM) and to explore correlations between cTSD and other anatomic and functional markers of disease status. Left ventricular (LV) dysfunction may indicate early disease in preclinical HCM (sarcomere mutation carriers without LV hypertrophy). Cardiac MRI feature tracking may be used to evaluate myocardial strain in carriers of HCM sarcomere mutation. Materials and Methods Participants with HCM and their family members participated in a prospective, multicenter, observational study (HCMNet). Genetic testing was performed in all participants. Study participants underwent cardiac MRI with temporal resolution at 40 msec or less. LV myocardial strain was analyzed by using feature-tracking software. Circumferential strain was measured at the epicardial and endocardial surfaces; their difference yielded the circumferential transmural strain difference (cTSD). Multivariable analysis to predict HCM status was performed by using multinomial logistic regression adjusting for age, sex, and LV parameters. Results Ninety-nine participants were evaluated (23 control participants, 34 participants with preclinical HCM [positive for sarcomere mutation and negative for LV hypertrophy], and 42 participants with overt HCM [positive for sarcomere mutation and negative for LV hypertrophy]). The average age was 25 years ± 11 and 44 participants (44%) were women. Maximal LV wall thickness was 9.5 mm ± 1.4, 9.8 mm ± 2.2, and 16.1 mm ± 5.3 in control participants, participants with preclinical HCM (P = .496 vs control participants), and participants with overt HCM (P < .001 vs control participants), respectively. cTSD for control participants, preclinical HCM, and overt HCM was 14% ± 4, 17% ± 4, and 22% ± 7, respectively (P < .01 for all comparisons). In multivariable models (controlling for septal thickness and log-transformed N-terminal brain-type natriuretic peptide), cTSD was predictive of preclinical and overt HCM disease status (P < .01). Conclusion Cardiac MRI feature tracking identifies myocardial dysfunction not only in participants with overt hypertrophic cardiomyopathy, but also in carriers of sarcomere mutation without left ventricular hypertrophy, suggesting that contractile abnormalities are present even when left ventricular wall thickness is normal. © RSNA, 2018 Online supplemental material is available for this article.
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