Cardiac magnetic resonance T2 mapping and feature tracking in athlete’s heart and HCM

Abstract

Objectives Distinguishing hypertrophic cardiomyopathy (HCM) from left ventricular hypertrophy (LVH) due to systematic training (athlete’s heart, AH) from morphologic assessment remains challenging. The purpose of this study was to examine the role of T2 mapping and deformation imaging obtained by cardiovascular magnetic resonance (CMR) to discriminate AH from HCM with (HOCM) or without outflow tract obstruction (HNCM). Methods Thirty-three patients with HOCM, 9 with HNCM, 13 strength-trained athletes as well as individual age- and gender-matched controls received CMR. For T2 mapping, GRASE-derived multi-echo images were obtained and analyzed using dedicated software. Besides T2 mapping analyses, left ventricular (LV) dimensional and functional parameters were obtained including LV mass per body surface area (LVMi), interventricular septum thickness (IVS), and global longitudinal strain (GLS). Results While LVMi was not significantly different, IVS was thickened in HOCM patients compared to athlete’s. Absolute values of GLS were significantly increased in patients with HOCM/HNCM compared to AH. Median T2 values were elevated compared to controls except in athlete’s heart. ROC analysis revealed T2 values (AUC 0.78) and GLS (AUC 0.91) as good parameters to discriminate AH from overall HNCM/HOCM. Conclusion Discrimination of pathologic from non-pathologic LVH has implications for risk assessment of competitive sports in athletes. Multiparametric CMR with parametric T2 mapping and deformation imaging may add information to distinguish AH from LVH due to HCM. Key Points • Structural analyses using T2 mapping cardiovascular magnetic resonance imaging (CMR) may help to further distinguish myocardial diseases. • To differentiate pathologic from non-pathologic left ventricular hypertrophy, CMR including T2 mapping was obtained in patients with hypertrophic obstructive/non-obstructive cardiomyopathy (HOCM/HNCM) as well as in strength-trained athletes. • Elevated median T2 values in HOCM/HNCM compared with athlete’s may add information to distinguish athlete’s heart from pathologic left ventricular hypertrophy.

The Role of Cardiovascular Magnetic Resonance Imaging in the Evaluation of Hypertrophic Cardiomyopathy

“…T2 mapping, however, demonstrates myocardial or interstitial water content with variations in signal intensity being useful in differentiating between different cardiac diseases [ 44 ]. In HCM, higher T2 values are reported, with the differences being accounted for on a structural level, which are purported to reflect myocyte degeneration, disarray, and replacement fibrosis [ 45 ]. In addition, it frequently corresponds with LGE, which may explain the process of initial dysfunction in HCM and the subsequent progression to fibrosis [ 46 , 47 ].…”

Asymptomatic myocardial dysfunction was revealed by feature tracking cardiac magnetic resonance imaging in patients with primary Sjögren’s syndrome

“…T1/T2 mapping is a method of quantifying tissue properties while FT is used to quantify LV regional function, and both have different purposes. Accordingly, some studies have reported that T1/T2 mapping and FT are complementary and that their combined use leads to improved lesion detection 30,31 . We also plan to combine these 2 methods in future studies.…”

Quantification of Myocardial Deformation Applying CMR-Feature-Tracking—All About the Left Ventricle?

“…LA conduit function was already impaired at early stages, therefore, representing the most sensitive LA strain parameter for early detection of fibrosis in HCM patients [72]. As another approach underlining benefits of CMR technique for diagnostic purposes, a multiparametric approach combining various CMR-FT and structural analyses provided important information for discrimination between HCM and athlete's cardiomyopathy [73]. Interestingly, in exercise-induced hypertrophied athlete's hearts, both LV and RV strain assessments even revealed differences between athletes of different sport disciplines [74], underlining the importance of comprehensive deformation analyses to capture and classify different exercise-induced myocardial adaptions of all cardiac chambers and to enable a distinction from hypertrophy of life-threatening cardiomyopathies [75].…”