Related Experiment Video
Updated: Dec 18, 2025
Ultrasonic Assessment of Myocardial Microstructure
Published on: January 14, 2014
Insight Into Myocardial Microstructure of Athletes and Hypertrophic Cardiomyopathy Patients Using Diffusion Tensor
Arka Das1, Amrit Chowdhary1, Chris Kelly2
1Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Insights
Diffusion tensor imaging (DTI) reveals distinct myocardial microstructural differences between hypertrophic cardiomyopathy (HCM) patients and athletes. DTI markers like mean diffusivity (MD) and fractional anisotropy (FA) can help differentiate these conditions.
Area of Science:
- Cardiovascular Imaging
- Biomedical Engineering
- Medical Physics
Background:
- Hypertrophic cardiomyopathy (HCM) is a leading cause of sudden cardiac death in young athletes.
- Distinguishing pathological HCM from physiological athletic cardiac hypertrophy is clinically challenging.
- Diffusion tensor imaging (DTI) MRI offers voxelwise characterization of myocardial microstructure by quantifying water molecule diffusion.
Purpose of the Study:
- To investigate microstructural differences in the myocardium of healthy volunteers, athletes, and HCM patients using DTI.
- To assess the utility of DTI-derived parameters in differentiating between these groups.
Main Methods:
- Prospective cohort study involving 20 healthy volunteers, 20 athletes, and 20 HCM patients.
- 3T DTI spin echo MRI sequences were acquired.
- In-house software calculated mean diffusivity (MD), fractional anisotropy (FA), and secondary eigenvector angles (E2A) as microstructural markers.
Main Results:
- Significant differences in DTI markers were observed across all three groups (HCM, athletes, volunteers).
- HCM patients exhibited higher MD and E2A, and lower FA compared to athletes and volunteers (P < 0.05).
- HCM patients showed an eccentric increase in E2A in thickened segments, distinct from the concentric pattern in athletes.
Conclusions:
- DTI effectively visualizes microstructural alterations in the myocardium, differentiating HCM from athletes and healthy individuals.
- Increased MD and decreased FA in HCM indicate greater diffusion amplitude and isotropy.
- Distinct patterns of E2A changes in HCM suggest unique myocardial sheetlet configurations, warranting further investigation for diagnostic potential.
Background:
Hypertrophic cardiomyopathy (HCM) remains the commonest cause of sudden cardiac death among young athletes. Differentiating between physiologically adaptive left ventricular (LV) hypertrophy observed in athletes' hearts and pathological HCM remains challenging. By quantifying the diffusion of water molecules, diffusion tensor imaging (DTI) MRI allows voxelwise characterization of myocardial microstructure.
Purpose:
To explore microstructural differences between healthy volunteers, athletes, and HCM patients using DTI.
Study Type:
Prospective cohort.
Population:
Twenty healthy volunteers, 20 athletes, and 20 HCM patients.
Field Strength/Sequence:
3T/DTI spin echo.
Assessment:
In-house MatLab software was used to derive mean diffusivity (MD) and fractional anisotropy (FA) as markers of amplitude and anisotropy of the diffusion of water molecules, and secondary eigenvector angles (E2A)-reflecting the orientations of laminar sheetlets.
Statistical Tests:
Independent samples t-tests were used to detect statistical significance between any two cohorts. Analysis of variance was utilized for detecting the statistical difference between the three cohorts. Statistical tests were two-tailed. A result was considered statistically significant at P ≤ 0.05.
Results:
DTI markers were significantly different between HCM, athletes, and volunteers. HCM patients had significantly higher global MD and E2A, and significantly lower FA than athletes and volunteers. (MDHCM = 1.52 ± 0.06 × 10-3 mm2 /s, MDAthletes = 1.49 ± 0.03 × 10-3 mm2 /s, MDvolunteers = 1.47 ± 0.02 × 10-3 mm2 /s, P < 0.05; E2AHCM = 58.8 ± 4°, E2Aathletes = 47 ± 5°, E2Avolunteers = 38.5 ± 7°, P < 0.05; FAHCM = 0.30 ± 0.02, FAAthletes = 0.35 ± 0.02, FAvolunteers = 0.36 ± 0.03, P < 0.05). HCM patients had significantly higher E2A in their thickest segments compared to the remote (E2Athickest = 66.8 ± 7, E2Aremote = 51.2 ± 9, P < 0.05).
Data Conclusion:
DTI depicts an increase in amplitude and isotropy of diffusion in the myocardium of HCM compared to athletes and volunteers as reflected by increased MD and decreased FA values. While significantly higher E2A values in HCM and athletes reflect steeper configurations of the myocardial sheetlets than in volunteers, HCM patients demonstrated an eccentric rise in E2A in their thickest segments, while athletes demonstrated a concentric rise. Further studies are required to determine the diagnostic capabilities of DTI.
Evidence Level:
1 TECHNICAL EFFICACY STAGE: 2.
More Related Videos
12:09Patient-specific Modeling of the Heart: Estimation of Ventricular Fiber Orientations
Published on: January 8, 2013
12:15Tissue Preparation Techniques for Contrast-Enhanced Micro Computed Tomography Imaging of Large Mammalian Cardiac Models with Chronic Disease
Published on: February 8, 2022
