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Magnetic Resonance Derived Myocardial Strain Assessment Using Feature Tracking
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Magnetic Resonance Derived Myocardial Strain Assessment Using Feature Tracking

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CMR-Derived Strain and Torsion Reveal Subclinical Dysfunction in Hypertrophic Cardiomyopathy: A Prospective

Alexandru Zlibut1,2, Ioana Danuta Muresan1, Michael Bietenbeck2

  • 1Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania.

Biomedicines
|August 28, 2025
PubMed

Insights

Cardiac magnetic resonance (CMR) feature tracking reveals early myocardial dysfunction in hypertrophic cardiomyopathy (HCM) patients, even before fibrosis is evident. Global left ventricular (LV) torsion is a highly sensitive marker for detecting this dysfunction and predicting prognosis.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Biophysics

Background:

  • Hypertrophic cardiomyopathy (HCM) often presents with preserved ejection fraction, masking subclinical myocardial dysfunction.
  • Conventional imaging techniques may fail to detect early signs of impaired cardiac mechanics in HCM.
  • Cardiac magnetic resonance (CMR) with feature tracking (FT) offers advanced capabilities for assessing myocardial deformation.

Purpose of the Study:

  • To evaluate the utility of CMR-derived strain and torsion parameters in detecting early myocardial dysfunction in HCM patients.
  • To compare the diagnostic performance of FT-CMR metrics with established markers of myocardial fibrosis.
  • To investigate the prognostic value of global left ventricular (LV) torsion in HCM.

Main Methods:

  • A prospective case-control study involving 150 HCM patients and 100 healthy controls.
  • Standardized CMR protocols were used to quantify global longitudinal strain (GLS), circumferential strain (GCS), radial strain (GRS), and LV torsion via FT-CMR.
  • Myocardial fibrosis was assessed using late gadolinium enhancement (LGE), native T1 mapping, and extracellular volume (ECV).

Main Results:

  • HCM patients exhibited significantly impaired GLS, GCS, GRS, and LV torsion compared to controls (p < 0.001).
  • These functional abnormalities were present even in LGE-negative HCM patients, indicating early remodeling.
  • Global LV torsion demonstrated superior diagnostic performance (AUC = 0.995) for LGE detection compared to GLS, T1 mapping, and ECV.

Conclusions:

  • CMR-derived strain and torsion parameters effectively detect subclinical myocardial dysfunction in HCM.
  • Global LV torsion is a sensitive and robust non-invasive marker with significant diagnostic and prognostic potential in HCM.
  • These findings highlight the value of advanced CMR techniques in understanding HCM pathophysiology and patient outcomes.

Keywords:
cardiac magnetic resonance imaginghypertrophic cardiomyopathyleft ventricle global longitudinal strainleft ventricle global torsionleft ventricle peak-systolic torsion

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