Diagnostic Performance of Mapping and Feature-Tracking Strain for Predicting Myocardial Fibrosis in Hypertrophic...

Late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR), reflecting myocardial fibrosis, is a known risk factor for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). Concerns about gadolinium deposition have encouraged the use of noncontrast MRI when possible. This study aimed to assess the diagnostic value of advanced noncontrast CMR techniques, including T1-T2 mapping and feature-tracking strain imaging, for evaluating myocardial fibrosis in HCM.

This retrospective cohort study included 120 HCM patients who underwent CMR between October 2022 and November 2024. Patients were divided into three groups based on fibrosis extent: No LGE, LGE < 15%, and LGE ≥ 15%. Left ventricular (LV) morphological, functional, mapping, and strain parameters were compared among HCM groups and with healthy controls. ROC analysis was performed to evaluate the diagnostic performance of these techniques for predicting fibrosis.

Mean global native T1 and maximal wall thickness (MWT) were significantly higher, and global strain values were significantly lower in HCM patients than in controls (all p < 0.05). Global longitudinal strain (GLS), global circumferential strain (GCS), segmental radial strain (SRS), and segmental longitudinal strain (SLS) were most strongly associated with fibrosis. The combination of GLS (≥ -12%), global native T1 (≥ 1,074 ms), and MWT (≥ 17 mm) yielded 72.2% sensitivity and 82.3% specificity (AUC: 0.773) for predicting LGE %.

Native T1 mapping and strain analysis-particularly GLS, GCS, SRS, and SLS-can noninvasively detect myocardial fibrosis in HCM and may assist in risk evaluation when gadolinium-based contrast is contraindicated.