Left Ventricular Strain Is Abnormal in Preclinical and Overt Hypertrophic Cardiomyopathy: Cardiac MR Feature Tracking

Vigneault, Davis M.; Yang, Eunice; Jensen, P. James; Tee, Michael; Farhad, Hoshang; Chu, Linda C.; Noble, Jessica; Day, Sharlene M.; Colan, Steven D.; Russell, Mark W.; Towbin, Jeffrey A.; Sherrid, Mark V.; Canter, Charles E.; Shi, Lei; Ho, Carolyn Y.; Bluemke, David A.

doi:10.1148/radiol.2018180339

Cited by 73 publications

(41 citation statements)

References 22 publications

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“…In hypertensive patients GLS is more abnormal in the presence of LVH and correlates with LV mass index [8,41] indicating that contractility decline worsens with disease progression. In HCM, GLS decline occurs already prior to phenotype development [14,42]. Our finding that GLS is able to differentiate between cohorts with similar LV mass index in the absence of LVH may therefore reflect on a relative delay in GLS attenuation when comparing HHD to HCM disease progression.…”

Section: Discussionmentioning

confidence: 93%

Cardiovascular magnetic resonance feature tracking strain analysis for discrimination between hypertensive heart disease and hypertrophic cardiomyopathy

et al. 2019

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Background Hypertensive heart disease (HHD) and hypertrophic cardiomyopathy (HCM) are both associated with an increased left ventricular (LV) wall thickness. Whilst LV ejection fraction is frequently normal in both, LV strain assessment could differentiate between the diseases. We sought to establish if cardiovascular magnetic resonance myocardial feature tracking (CMR-FT), an emerging method allowing accurate assessment of myocardial deformation, differentiates between both diseases. Additionally, CMR assessment of fibrosis and LV hypertrophy allowed association analyses and comparison of diagnostic capacities. Methods Two-hundred twenty-four consecutive subjects (53 HHD, 107 HCM, and 64 controls) underwent 1.5T CMR including native myocardial T 1 mapping and late gadolinium enhancement (LGE). Global longitudinal strain (GLS) was assessed by CMR-FT (CVi42, Circle Cardiovascular Imaging Inc.). Results GLS was significantly higher in HCM patients (-14.7±3.8 vs. -16.5±3.3% [HHD], P = 0.004; or vs. -17.2±2.0% [controls], P<0.001). GLS was associated with LV mass index (HHD, R = 0.419, P = 0.002; HCM, R = 0.429, P<0.001), and LV ejection fraction (HHD, R = -0.493, P = 0.002; HCM, R = -0.329, P<0.001). In HCM patients, GLS was also associated with global native T 1 (R = 0.282, P = 0.003), and LGE volume (ρ = 0.380, P<0.001). Discrimination between HHD and HCM by GLS (c = 0.639, 95% confidence interval [CI] 0.550–0.729) was similar to LV mass index (c = 0.643, 95% CI 0.556–0.731), global myocardial native T 1 (c = 0.718, 95% CI 0.638–0.799), and LGE volume (c = 0.680, 95% CI 0.585–0.775). Conclusion CMR-FT GLS differentiates between HHD and HCM. In HCM patients GLS is associated with myocardial fibrosis. The discriminatory capacity of CMR-FT GLS is similar to LV hypertrophy and fibrosis imaging markers.

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Section: Discussionmentioning

confidence: 93%

Cardiovascular magnetic resonance feature tracking strain analysis for discrimination between hypertensive heart disease and hypertrophic cardiomyopathy

et al. 2019

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“…Compared with healthy control cats, the cats with preclinical HCM in our study had decreased longitudinal and radial deformation with similar circumferential S and SR, that was assessed at the mid-myocardium level, in contrast to the previously cited study, 36 where the whole layer circumferential results were lower in asymptomatic cats with HCM, but were not statistically different on a previous study from the same group. 19 There are similar discrepancies in circumferential S and SR in humans 12,14,16 and there is currently interest in the assessment of a transmural strain difference both on MRI and echocardiography 46,47 in human cardiology.…”

Section: Discussionmentioning

confidence: 99%

Speckle tracking echocardiography in cats with preclinical hypertrophic cardiomyopathy

Spalla

Boswood

Connolly

et al. 2019

Veterinary Internal Medicne

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Background Cats with hypertrophic cardiomyopathy (HCM) have decreased left ventricular (LV) longitudinal deformation detected by mitral annular plane systolic excursion (MAPSE) and speckle tracking echocardiography. People with preclinical HCM have decreased systolic LV longitudinal and radial strain (S) and strain rate (SR), with preserved circumferential S and SR. Hypothesis/Objectives Cats with preclinical HCM have decreased systolic LV deformation compared to normal cats. Animals Seventy‐three client‐owned cats with (n = 37) and without (n = 36) preclinical HCM. Methods Retrospective echocardiographic study. Left and right ventricular longitudinal S and SR, LV radial and circumferential S and SR were calculated by STE. Left ventricular mass was also calculated. Correlation between STE variables and LV hypertrophy was determined and receiver‐operating characteristic (ROC) curves were plotted for prediction of HCM. Results Cats with HCM had smaller absolute longitudinal S (−14.8 ± 3.3% vs −19.7 ± 2.7%, P < .001), longitudinal SR (−2.36 ± 0.62 vs −2.95 ± 0.68 second −1 , P < .001), radial S (46.2 ± 21.3% vs 66.7 ± 17.6%, P < .001), and radial SR (5.60 ± 2.08 vs 6.67 ± 1.8 second −1 , P < .001) compared to healthy controls. No difference was observed for circumferential S and SR. Cats with HCM had greater LV mass (13.2 ± 3.7 g vs 8.6 ± 2.7 g, P < .001). The ROC with the greatest area under the curve (AUC) for the identification of HCM (0.974) was plotted from a logistic regression equation combining LV mass, MAPSE at the free wall, and LV internal diameter in diastole (LVIDd). Conclusions and clinical importance Cats with preclinical HCM have decreased long axis and radial deformation. Decreased longitudinal deformation and decreased LVIDd are factors that would support a diagnosis of HCM.

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“…Several echocardiography studies assessed myocardial strain using a multilayer approach in normal subjects 22–25 , coronary artery disease 26 , aortic stenosis 27 , hypertrophic cardiomyopathy 28,29 . There is a consensus among these studies regarding the existence of a marked gradient between subendocardial and subepicardial regions of the myocardium in normal subjects which decreases proportionally with the contractile impairment: in coronary artery disease (CAD) patients this gradient decreases with the severity of coronary obstruction 26 , in hypertension it is only mildly blunted compared with hypertrophic cardiomyopathy 28 .…”

Section: Discussionmentioning

confidence: 99%

Range Variability in CMR Feature Tracking Multilayer Strain across Different Stages of Heart Failure

Tanacli

Hashemi

Lapinskas

et al. 2019

Sci Rep

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Heart failure (HF) is associated with progressive ventricular remodeling and impaired contraction that affects distinctly various regions of the myocardium. Our study applied cardiac magnetic resonance (CMR) feature tracking (FT) to assess comparatively myocardial strain at 3 distinct levels: subendocardial (Endo-), mid (Myo-) and subepicardial (Epi-) myocardium across an extended spectrum of patients with HF. 59 patients with HF, divided into 3 subgroups as follows: preserved ejection fraction (HFpEF, N = 18), HF with mid-range ejection fraction (HFmrEF, N = 21), HF with reduced ejection fraction (HFrEF, N = 20) and a group of age- gender- matched volunteers (N = 17) were included. Using CMR FT we assessed systolic longitudinal and circumferential strain and strain-rate at Endo-, Myo- and Epi- levels. Strain values were the highest in the Endo- layer and progressively lower in the Myo- and Epi- layers respectively, this gradient was present in all the patients groups analyzed but decreased progressively in HFmrEF and further on in HFrEF groups. GLS decreased with the severity of the disease in all 3 layers: Normal > HFpEF > HFmrEF > HFrEF (Endo-: −23.0 ± 3.5 > −20.0 ± 3.3 > −16.4 ± 2.2 > −11.0 ± 3.2, p < 0.001, Myo-: −20.7 ± 2.4 > −17.5.0 ± 2.6 > −14.5 ± 2.1 > −9.6 ± 2.7, p < 0.001; Epi-: −15.7 ± 1.9 > −12.2 ± 2.1 > −10.6 ± 2.3 > −7.7 ± 2.3, p < 0.001). In contrast, GCS was not different between the Normal and HFpEF (Endo-: −34.5 ± 6.2 vs −33.9 ± 5.7, p = 0.51; Myo-: −21.9 ± 3.8 vs −21.3 ± 2.2, p = 0.39, Epi-: −11.4 ± 2.0 vs −10.9 ± 2.3, p = 0.54) but was, as well, markedly lower in the systolic heart failure groups: Normal > HFmrEF > HFrEF (Endo-: −34.5 ± 6.2 > −20.0 ± 4.2 > 12.3 ± 4.2, p < 0.001; Myo-: −21.9 ± 3.8 > −13.0 ± 3.4 > −8.0 ± 2.7. p < 0.001; Epi-: −11.4 ± 2.0 > −7.9 ± 2.3 > −4.5 ± 1.9. p < 0.001). CMR feature tracking multilayer strain assessment identifies large range differences between distinct myocardial regions. Our data emphasizes the importance of sub-endocardial myocardium for cardiac contraction and thus, its predilect role in imaging detection of functional impairment. CMR feature tracking offers a convenient, readily available, platform to evaluate myocardial contraction with excellent spatial resolution, rendering further details about discrete areas of the myocardium. Using this technique across distinct groups of patients with heart failure (HF), we demonstrate that subendocardial regions of the myocardium exhibit much higher strain values than mid-myocardium or subepicardial and are more sensitive to detect contractile impairment. We also show comparatively higher values of circumferential strain compared with longitudinal and a higher sensitivity to detect contractile impairment. A newly characterized group of patients, HF with mid-range ejection fraction (EF), shows similar traits of decompensation but has relatively higher strain values as patients with HF with reduced EF.

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Left Ventricular Strain Is Abnormal in Preclinical and Overt Hypertrophic Cardiomyopathy: Cardiac MR Feature Tracking

Cited by 73 publications

References 22 publications

Cardiovascular magnetic resonance feature tracking strain analysis for discrimination between hypertensive heart disease and hypertrophic cardiomyopathy

Cardiovascular magnetic resonance feature tracking strain analysis for discrimination between hypertensive heart disease and hypertrophic cardiomyopathy

Speckle tracking echocardiography in cats with preclinical hypertrophic cardiomyopathy

Range Variability in CMR Feature Tracking Multilayer Strain across Different Stages of Heart Failure

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