Abstract
Clinical presentation of left ventricular non-compaction cardiomyopathy (LVNC) can be heterogeneous from asymptomatic expression to congestive heart failure. Deformation indices assessed by cardiovascular magnetic resonance (CMR) can determine subclinical alterations of myocardial function and have been reported to be more sensitive to functional changes than ejection fraction. The objective of the present study was to investigate the determinants of myocardial deformation indices in patients with LVNC. Twenty patients with LVNC (44.7 ± 14.0 years) and twenty age- and gender-matched controls (49.1 ± 12.4 years) underwent functional CMR imaging using an ECG-triggered steady state-free-precession sequence (SSFP). Deformation indices derived with a feature tracking algorithm were calculated including end-systolic global longitudinal strain (GLS), circumferential strain (GCS), longitudinal and circumferential strain rate (SRll and SRcc). Twist and rotation were determined using an in-house developed post-processing pipeline. Global deformation indices (GLS, GCS, SRll and SRcc) were significantly lower in patients with LVNC compared to healthy controls (all, p < 0.01), especially for midventricular and apical regions. Apical rotation and twist were impaired for LVNC (p = 0.007 and p = 0.012), but basal rotation was preserved. Deformation indices of strain, strain rate and twist correlated well with parameters of the non-compacted myocardium, but not with the total myocardial mass or the thinning of the compacted myocardium, e.g. r = 0.595 between GLS and the non-compacted mass (p < 0.001). In conclusion, CMR deformation indices are reduced in patients with LVNC especially in affected midventricular and apical slices. The impairment of all strain and twist parameters correlates well with the extent of non-compacted myocardium.
Highlights
Left ventricular non-compaction cardiomyopathy (LVNC) is a congenital cardiomyopathy that arises from a premature arrest of myocardial compaction during embryogenesis[1]
As cardiovascular magnetic resonance (CMR) deformation analysis using feature tracking algorithm can be derived from standard, cine steady-state-free precession (SSFP) images without the need for additional, time-consuming sequences and due to its reproducible, in-plane image acquisition this approach may have potential advantages
As a recent study indicated that CMR-based global longitudinal strain (GLS), GCS and GRS were impaired in left ventricular non-compaction cardiomyopathy (LVNC) patients[10], the aim of the present study was to investigate in addition strain rate and twist in LVNC patients as well as regional strain parameters and to determine their correlation with morphological aspects of LVNC
Summary
Left ventricular non-compaction cardiomyopathy (LVNC) is a congenital cardiomyopathy that arises from a premature arrest of myocardial compaction during embryogenesis[1] As a result, it is phenotypically characterized by a thin, compacted epicardial layer in contrast to a prominent non-compacted endocardial layer with multiple trabeculations and deep intertrabecular recesses. Strain parameters as assessed by speckle tracking echocardiography have already shown reduced values for patients with LVNC even when LVEF was preserved[4,5,6]. This indicates that strain parameters are more sensitive to functional changes of the heart. As a recent study indicated that CMR-based GLS, GCS and GRS were impaired in LVNC patients[10], the aim of the present study was to investigate in addition strain rate and twist in LVNC patients as well as regional strain parameters and to determine their correlation with morphological aspects of LVNC
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