Multi-parametric assessment of left ventricular hypertrophy using late gadolinium enhancement, T1 mapping and strain-encoded cardiovascular magnetic resonance

Abstract

Aim To evaluate the ability of single heartbeat fast-strain encoded (SENC) cardiovascular magnetic resonance (CMR) derived myocardial strain to discriminate between different forms of left ventricular (LV) hypertrophy (LVH). Methods 314 patients (228 with hypertensive heart disease (HHD), 45 with hypertrophic cardiomyopathy (HCM), 41 with amyloidosis, 22 competitive athletes, and 33 healthy controls) were systematically analysed. LV ejection fraction (LVEF), LV mass index and interventricular septal (IVS) thickness, T1 mapping and atypical late gadolinium enhancement (LGE) were assessed. In addition, the percentage of LV myocardial segments with strain ≤ − 17% (%normal myocardium) was determined. Results Patients with amyloidosis and HCM exhibited the highest IVS thickness (17.4 ± 3.3 mm and 17.4 ± 6 mm, respectively, p < 0.05 vs. all other groups), whereas patients with amyloidosis showed the highest LV mass index (95.1 ± 20.1 g/m2, p < 0.05 vs all others) and lower LVEF compared to controls (50.5 ± 9.8% vs 59.2 ± 5.5%, p < 0.05). Analysing subjects with mild to moderate hypertrophy (IVS 11–15 mm), %normal myocardium exhibited excellent and high precision, respectively for the differentiation between athletes vs. HCM (sensitivity and specificity = 100%, Area under the curve; AUC%normalmyocardium = 1.0, 95%CI = 0.85–1.0) and athletes vs. HHD (sensitivity = 83%, specificity = 75%, AUC%normalmyocardium = 0.85, 95%CI = 0.78–0.90). Combining %normal myocardial strain with atypical LGE provided high accuracy also for the differentiation of HHD vs. HCM (sensitivity = 82%, specificity = 100%, AUCcombination = 0.92, 95%CI = 0.88–0.95) and HCM vs. amyloidosis (sensitivity = 83%, specificity = 100%, AUCcombination = 0.83, 95%CI = 0.60–0.96). Conclusion Fast-SENC derived myocardial strain is a valuable tool for differentiating between athletes vs. HCM and athletes vs. HHD. Combining strain and LGE data is useful for differentiating between HHD vs. HCM and HCM vs. cardiac amyloidosis.

Left-Ventricular Reference Myocardial Strain Assessed by Cardiovascular Magnetic Resonance Feature Tracking and fSENC—Impact of Temporal Resolution and Cardiac Muscle Mass

“…We provided cut-off values with high sensitivity and specificity for clinical work. Although our results pointed out the discrimination between HCM patients and healthy subjects, there is also a great potential for differentiating various forms of left ventricular hypertrophy ( 35 ).…”

Diagnostic Work-Up of Cardiac Amyloidosis Using Cardiovascular Imaging: Current Standards and Practical Algorithms

“…In addition, patients with amyloidosis showed a base-to-apex strain gradient, which was not the case in hypertrophic cardiomyopathy and hypertensive heart disease. 74 This base-to-apex strain gradient, which was initially described by echocardiographic speckle tracking as "apical sparing" [35][36][37] was also recently confirmed using strain analysis by CMR, being associated with less LGE burden in apical compared to mid and basal segments. Thus, relatively preserved strain in apical segments in patients with cardiac amyloidosis may be at least partially explained by the increased burden of amyloid deposition and fibrosis in mid and basal versus apical segments.…”

“…73 Likewise, fast-SENC aided the diagnostic classification of patients with different forms of LV hypertrophy, effectively differentiating patients with cardiac amyloidosis. 74 Myocardial strain derived from the fast-SENC successfully differentiated between patients with hypertrophic cardiomyopathy and amyloidosis, the latter exhibiting lower global strain values. In addition, patients with amyloidosis showed a base-to-apex strain gradient, which was not the case in hypertrophic cardiomyopathy and hypertensive heart disease.…”

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

“…With a higher spatial resolution offered by CMR, it is argued that it displays a more superior and sensitive estimation of LV function than echocardiography. Here, LV strain is assessed using myocardial tissue tagging, where tagged CMR can assess regional myocardial mechanics at different time-points during the cardiac cycle [ 49 , 50 ]. Several studies have reported HCM patients, despite a seemingly normal LV ejection fraction, as having globally reduced strain, which is associated with both increased mortality and heart failure events [ 51 , 52 ].…”