Cardiovascular magnetic resonance based diagnosis of left ventricular non-compaction cardiomyopathy: impact of cine bSSFP strain analysis

John G Dreisbach,Erwin Oechslin,Bernd J Wintersperger,Christian P Houbois,Heather Ross,Kate Hanneman,Shobhit Mathur

doi:10.1186/s12968-020-0599-3

Abstract

BackgroundInvestigation of the myocardial strain characteristics of the left ventricular non-compaction (LVNC) phenotype with cardiovascular magnetic resonance (CMR) feature tracking.MethodsCMR cine balanced steady-state free precession data sets of 59 retrospectively identified LVNC phenotype patients (40 years, IQR: 28–50 years; 51% male) and 36 healthy subjects (39 years, IQR: 30–47 years; 44% male) were evaluated for LV volumes, systolic function and mass. Hypertrabeculation in patients and healthy subjects was evaluated against established CMR diagnostic criteria. Global circumferential strain (GCS), global radial strain (GRS) and global longitudinal strain (GLS) were evaluated with feature-tracking software. Subgroup analyses were performed in patients (n = 25) and healthy subjects (n = 34) with normal LV volumetrics, and with healthy subjects (n = 18) meeting at least one LVNC diagnostic criteria.ResultsAll LVNC phenotype patients, as well as a significant proportion of healthy subjects, met morphology-based CMR diagnostic criteria: non-compacted (NC): compacted myocardial diameter ratio > 2.3 (100% vs. 19.4%), NC mass > 20% (100% vs. 44.4%) and > 25% (100% vs. 13.9%), and NC mass indexed to body surface area > 15 g/m2 (100% vs. 41.7%). LVNC phenotype patients demonstrated reduced GRS (26.4% vs. 37.1%; p < 0.001), GCS (− 16.5% vs. -20.5%; p < 0.001) and GLS (− 14.6% vs. -17.1%; p < 0.001) compared to healthy subjects, with statistically significant differences persisting on subgroup comparisons of LVNC phenotype patients with healthy subjects meeting diagnostic criteria. GCS also demonstrated independent and incremental diagnostic value beyond each of the morphology-based CMR diagnostic criteria.ConclusionsLVNC phenotype patients demonstrate impaired strain by CMR feature tracking, also present on comparison of subjects with normal LV volumetrics meeting diagnostic criteria. The high proportion of healthy subjects meeting morphology-based CMR diagnostic criteria emphasizes the important potential complementary diagnostic value of strain in differentiating LVNC from physiologic hypertrabeculation.

Highlights

Investigation of the myocardial strain characteristics of the left ventricular non-compaction (LVNC) phenotype with cardiovascular magnetic resonance (CMR) feature tracking
In light of the limitations of current morphologybased diagnostic criteria, this study investigated functional parameters including myocardial strain characteristics among LVNC phenotype patients and healthy subjects with CMR feature tracking (FT) to explore potential complementary diagnostic utility
LV left ventricle, LVNC left ventricular non-compaction cardiomyopathy, Body surface area (BSA) body surface area, bpm beats per minute, End-diastolic volume (EDV) end-diastolic volume, End-diastolic volume indexed to body surface area (EDVI) end-diastolic volume indexed to BSA, End-systolic volume (ESV) end-systolic volume, End-systolic volume indexed to body surface area (ESVI) end-systolic volume indexed to BSA, Stroke volume (SV) stroke volume, SVi stroke volume indexed to BSA, EF ejection fraction, CO cardiac output, LVM left ventricular mass, LVMI LVM indexed to BSA aFisher’s exact test bWilcoxon rank sum test cIndependent samples t-test

Summary

Introduction

Investigation of the myocardial strain characteristics of the left ventricular non-compaction (LVNC) phenotype with cardiovascular magnetic resonance (CMR) feature tracking. Left ventricular non-compaction cardiomyopathy (LVNC) is a rare cardiomyopathy that can occur in isolation or in association with other congenital and acquired cardiac pathologies [1]. It is characterised by two distinct layers of the left ventricular (LV) myocardium – an endocardial layer of heavily hypertrabeculated myocardium with deep inter-trabecular recesses, and an abnormally thin epicardial layer of compacted myocardium [2]. It is critical to distinguish patients with physiologic remodelling of the myocardium from those with pathologic remodelling or LVNC [14]

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