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Prognostic value of left ventricular trabeculae fractal analysis in patients with dilated cardiomyopathy

Wei-Hui Xie1, Bing-Hua Chen1, Dong-Aolei An1

  • 1Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

Journal of Cardiovascular Magnetic Resonance : Official Journal of the Society for Cardiovascular Magnetic Resonance
|February 1, 2024
PubMed

Insights

Left ventricular maximal apical fractal dimension (FD) predicts adverse outcomes in dilated cardiomyopathy (DCM) patients. This measure offers incremental prognostic value beyond traditional clinical and imaging risk factors.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Biophysics

Background:

  • The prognostic implications of left ventricular (LV) myocardial trabecular complexity in dilated cardiomyopathy (DCM) using cardiovascular magnetic resonance (CMR) are not well understood.
  • This study investigated the predictive capability of LV myocardial trabecular complexity via fractal analysis in DCM patients.

Purpose of the Study:

  • To assess the prognostic value of LV myocardial trabecular complexity using fractal analysis in patients diagnosed with DCM.
  • To determine if LV maximal apical FD provides incremental prognostic information.

Main Methods:

  • Prospective enrollment of 403 DCM patients undergoing CMR between March 2017 and November 2021.
  • Quantification of LV trabeculae complexity using fractal dimension (FD) analysis of the endocardial border on CMR.
  • Primary endpoints included all-cause death and heart failure hospitalization; secondary endpoints were cardiac death, analyzed using Cox regression and Kaplan-Meier survival analysis.

Main Results:

  • After a median follow-up of 43 months, 87 patients reached primary endpoints and 24 reached secondary endpoints.
  • LV maximal apical FD emerged as a significant independent predictor of adverse outcomes (HR=1.179, P<0.001) after multivariate adjustment.
  • The addition of LV maximal apical FD significantly enhanced the prognostic value of conventional clinical and imaging risk factors (C-statistic: 0.84-0.88, P<0.001).

Conclusions:

  • Left ventricular maximal apical fractal dimension is an independent predictor of adverse clinical outcomes in patients with DCM.
  • LV maximal apical FD offers significant incremental prognostic value when combined with established clinical and imaging risk factors.
Abstract

Keywords:
Cardiac magnetic resonanceDilated cardiomyopathyFractal analysisFractal dimension

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