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Updated: May 6, 2026
Ultrasonic Assessment of Myocardial Microstructure
Published on: January 14, 2014
Early Identification of Myocardial Microstructural Alterations in Hypertrophic Cardiomyopathy with in Vivo Cardiac
Zhixiang Dong1, Yun Tang1, Peng Sun1
1From the Department of Magnetic Resonance Imaging, Radiology Imaging Center, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing 100037, China (Z.D., Y.T., G.Y., X.M., S.Y., J.W., X.X., K.Y., M.L., X.C., S.Z.); Clinical and Technical Support, Philips Healthcare, Beijing, China (P.S.); and Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, SZ University Town, Shenzhen, China (K.Z., Y.Z.).
Insights
Cardiac diffusion-tensor imaging (cDTI) reveals myocardial disarray in hypertrophic cardiomyopathy (HCM) even without fibrosis or hypertrophy. This technique shows potential for improved tissue characterization in HCM patients.
Area of Science:
- Cardiovascular Imaging
- Medical Physics
- Biomedical Engineering
Background:
- Hypertrophic cardiomyopathy (HCM) is a complex cardiac condition characterized by myocardial abnormalities.
- Current cardiac MRI techniques like late gadolinium enhancement (LGE) and T1 mapping identify fibrosis and hypertrophy but may miss subtle microstructural changes.
- Understanding myocardial microstructure is crucial for accurate diagnosis and management of HCM.
Purpose of the Study:
- To investigate the diffusion characteristics of the myocardium in patients with HCM using in vivo cardiac diffusion-tensor imaging (cDTI).
- To assess the capability of cDTI in detecting abnormal myocardial microstructure beyond established MRI findings of fibrosis and hypertrophy in HCM.
Main Methods:
- Prospective study involving 35 HCM patients and 15 healthy volunteers undergoing cardiac MRI.
- Cardiac MRI included cine, LGE, T1 mapping, and cDTI at 3.0-T.
- Segmental analysis of midventricular sections using American Heart Association 16-segment model; statistical comparisons included repeated measure ANOVA, Friedman test, and linear mixed-effects models.
- Receiver operating characteristic (ROC) analysis evaluated the diagnostic performance of cDTI parameters.
Main Results:
- HCM patients exhibited significantly reduced fractional anisotropy (FA) and increased diastolic second eigenvector angle (E2A) compared to controls (P < .001).
- These differences persisted in HCM segments without hypertrophy or LGE, indicating subclinical microstructural changes.
- FA and diastolic E2A demonstrated superior diagnostic performance (AUC 0.81 and 0.79, respectively) compared to native T1 values (AUC 0.67) in differentiating HCM segments.
Conclusions:
- In vivo cDTI can identify myocardial disarray and abnormal microstructural dynamics in HCM, even in the absence of hypertrophy or fibrosis.
- cDTI parameters, particularly FA and diastolic E2A, show significant potential for characterizing myocardial tissue in HCM.
- This suggests cDTI is a valuable tool for enhancing the understanding and diagnosis of HCM.
Abstract:
Purpose To explore the diffusion characteristics of hypertrophic cardiomyopathy (HCM) using in vivo cardiac diffusion-tensor imaging (cDTI) and to determine whether cDTI could help identify abnormal myocardium beyond cardiac MRI findings of fibrosis and hypertrophy. Materials and Methods In this prospective study conducted from April to August 2023, participants with HCM and healthy volunteers were enrolled for cardiac MRI evaluation, including cine, late gadolinium enhancement (LGE), T1 mapping, and cDT imaging, using a 3.0-T scanner. LGE was performed only in participants with HCM. All cardiac MR images of the midventricular section were divided into six American Heart Association segments for segmental analysis. Repeated measure analysis of variance and Friedman test were used to compare cDTI parameters among different segments, and a linear mixed-effects model was fitted to account for within-participant clustering. Diagnostic performance of cDTI parameters in discriminating HCM segments from normal segments was assessed using receiver operating characteristic (ROC) analysis. Results Thirty-five participants with HCM (mean age, 46 years ± 13 [SD]; 19 [54%] male) and 15 healthy volunteers (mean age, 43 years ± 17; nine [60%] male) were included. Compared with controls, the HCM group showed significantly reduced fractional anisotropy (FA) (mean, 0.33 ± 0.05 vs 0.46 ± 0.04; P < .001) and increased diastolic second eigenvector angle (E2A) (mean, 48.85° ± 7.13 vs 35.05° ± 5.06; P < .001). In segmental analysis, FA and diastolic E2A of HCM segments with no hypertrophy or LGE also significantly differed from controls (estimated marginal mean, FA: 0.39 [95% CI: 0.38, 0.41] vs 0.45 [95% CI: 0.43, 0.47]; E2A: 46.03° [95% CI: 43.45, 48.62] vs 35.69° [95% CI: 31.69, 39.69]; both P < .001), with no evidence of a difference in native T1 values (estimated marginal mean, 1282.43 msec [95% CI: 1267.55, 1297.30] vs 1265.57 msec [95% CI: 1242.86, 1288.28]; P = .47). FA (area under the ROC curve [AUC], 0.81 [95% CI: 0.76, 0.86]) and diastolic E2A (AUC, 0.79 [95% CI: 0.74, 0.84]) showed higher performance than native T1 (AUC, 0.67 [95% CI: 0.61, 0.72]) in identifying HCM segments from normal segments (P < .001 and P = .007, respectively). Conclusion Myocardial disarray and abnormal microstructural dynamics of HCM can be identified by using in vivo cDTI even in the absence of hypertrophy or fibrosis, suggesting the potential value of cDTI in tissue characterization of HCM. Keywords: Cardiovascular MR Imaging, Hypertrophic Cardiomyopathy, Diffusion-Tensor Imaging, Myocardial Microstructure Supplemental material is available for this article. Published under a CC BY 4.0 license.
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