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3-Dimensional regional and global strain abnormalities in hypertrophic cardiomyopathy

Alessandro Satriano1, Bobak Heydari2,3, Namrata Guron1

  • 1Division of Cardiology, Department of Cardiac Sciences, Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Canada.

The International Journal of Cardiovascular Imaging
|May 31, 2019
PubMed

Insights

Hypertrophic cardiomyopathy (HCM) shows reduced principal strain in non-enhanced myocardium. This strain is further diminished in patients with extensive late gadolinium enhancement, indicating potential prognostic value.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Biophysics

Background:

  • Hypertrophic cardiomyopathy (HCM) is a genetic heart condition characterized by myocardial disarray, hypertrophy, and fibrosis.
  • Reduced global longitudinal strain and late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) are linked to adverse prognosis in HCM.
  • Current assessments often focus on LGE, but strain characteristics of non-enhanced myocardium warrant further investigation.

Purpose of the Study:

  • To evaluate 3D principal and conventional strain characteristics in the non-enhanced myocardium of patients with HCM.
  • To compare strain parameters between HCM patients and healthy controls.
  • To investigate the association between strain measures in non-enhanced myocardium and indicators of disease severity like LGE and left ventricular (LV) mass.

Main Methods:

  • Cardiac magnetic resonance imaging (CMR) was performed on 51 HCM patients and 38 healthy controls.
  • 3D principal and conventional strain analysis (longitudinal, circumferential, radial) was conducted on the non-enhanced myocardial segments.
  • Statistical analyses were used to compare strain parameters between groups and correlate them with clinical and imaging variables, including indexed LV mass and LGE extent.

Main Results:

  • Principal strain was significantly reduced in the non-enhanced myocardium of HCM patients compared to controls (maximum principal: 51.5 ± 23.7% vs. 75.1 ± 21.4%, P < 0.0001).
  • Principal strain was incrementally reduced in HCM patients with extensive global LGE (≥15%), along with longitudinal and circumferential strain.
  • All strain measures in non-enhanced myocardium were independently associated with indexed LV mass after adjustment.

Conclusions:

  • 3D principal strain of non-enhanced myocardium is significantly reduced in HCM patients.
  • This reduction is incrementally worse in patients with more extensive LGE, suggesting strain analysis provides valuable insights beyond LGE.
  • Comprehensive strain assessment, including principal strain of non-enhanced myocardium, may enhance routine CMR evaluation of HCM patients.

Keywords:
CardiomyopathyContractile functionHypertrophyMagnetic resonance imaging

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