Fractal Analysis of Myocardial Trabeculations in 2547 Study Participants: Multi-Ethnic Study of Atherosclerosis

Abstract

).q RSNA, 2015 Purpose:To quantitatively determine the population variation and relationship of left ventricular (LV) trabeculation to LV function, structure, and clinical variables. Materials andMethods:This HIPAA-compliant multicenter study was approved by institutional review boards of participating centers. Results:Included were 2547 participants (mean age, 68.7 years 6 9.1 [standard deviation]; 1211 men). FD MaxApical are in arbitrary units. FD MaxApical reference ranges for BMI 30 kg/m 2 or greater (n = 163), 25 kg/m 2 or greater to less than 30 kg/m 2 (n = 206), and less than 25 kg/m 2 (n = 235) were 1.203 6 0.06 (95% confidence interval: 1.194, 1.212), 1.194 6 0.06 (95% confidence interval: 1.186, 1.202), and 1.169 6 0.05 (95% confidence interval: 1.162, 1.176), respectively. In the entire cohort, adjusted for anthropometrics, trabeculation was higher in African American participants (standardized b [sb] = 0.09; P  .001) and Hispanic participants (sb = 0.05; P = .013) compared with white participants and was also higher in African American participants compared with Chinese American participants (sb = 0.08; P = .01), and this persisted after adjustment for hypertension and LV size. Hypertension (sb = 0.07; P , .001), LV mass (sb = 0.22; P , .001), and wall thickness (sb = 0.27; P , .001) were positively associated with FD MaxApical even after adjustment. In the group with BMIs less than 25 kg/ m 2 , Chinese American participants had less trabeculation than white participants (sb = 20.15; P = .032). Conclusion:Fractal analysis of cardiac MR imaging data measures endocardial complexity, which helps to differentiate normal from abnormal trabecular patterns in healthy versus diseased hearts. Trabeculation is influenced by race and/or ethnicity and, more importantly, by cardiac loading conditions and comorbidities. Clinicians who interpret cine MR imaging data should expect slightly less endocardial complexity in Chinese American patients and more in African American patients, Hispanic patients, hypertensive patients, and those with hypertrophy.q RSNA, 2015

Clinical and prognostic relevancy of left ventricular trabeculation assessed by cardiac magnetic resonance in patients with dilated cardiomyopathy

“…Amzulescu et al [15] divided their study group into tertiles but only for the purpose of survival analysis. In the MESA study, fractal analysis was performed on a non-heart failure population [1,24]. Surprisingly, unlike other authors, we found that patients with a high degree of trabeculation had better cardiac function and lower NT-proBNP.…”

“…Possibly, this can be explained by the tertile study population allotment or by different study group characteristics. Our patient population was much younger with more severe heart failure symptoms compared to either Amzulescu's et al [15] or MESA's cohorts [24]. Some small studies suggested that noncompaction phenotype might indicate a more severe form of DCM [25].…”

“…In this study, the beginning of the observation period was at the CMR scan time point, as was determined in previous studies. In the MESA study, hypertrabeculation was not associated with worse outcome in the 10-year follow up [24]. Also, Amzulescu et al [15] observed a small number of MACEs in patients with a high amount of trabeculation.…”

“…Jacquier proposed that a noncompacted to compacted ratio > 20% should be considered as abnormal [10]. However, based on the finding that almost 20% of healthy subjects fulfilled archetypal Jacquier criteria, other researchers concluded that this seemed to be inaccurate to credibly ascertain the truly pathological amount of trabeculation [1,11,15,24]. They even postulated that this border should be pushed up to 30% or more [15].…”

Community delivery of semiautomated fractal analysis tool in cardiac mr for trabecular phenotyping

“…The fractal signature of the adult human heart has been shown to differ by ethnicity, LV mass, coexistent hypertension, and increased body mass index (6). Cardiac MR fractal analysis is currently being used to understand the FD of the adult human heart at scale, in both the UK Biobank Study (n=100,000) and the US Multi-Ethnic Study of Atherosclerosis (MESA, >3,000).…”