Abstract
AimTo 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).Methods314 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.ResultsPatients 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).ConclusionFast-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.
Highlights
Left ventricular (LV) hypertrophy (LVH) can be part of an adaptation process in athletes; due to increased afterload in patients with hypertensive heart disease (HHD); Giusca et al J Cardiovasc Magn Reson (2021) 23:92 or an expression of myocyte hypertrophy and disarray in hypertrophic cardiomyopathy (HCM)
Patients were selected with a clinical indication for the Cardiovascular magnetic resonance (CMR) examination that was related to (1) further evaluation of Left ventricular hypertrophy (LVH) diagnosed by echocardiography (2) evaluation of an underlying cause for symptoms of heart failure (3) evaluation of the presence and extent of scar tissue in patients with suspected or known history of cardiomyopathy
Data were available for 369 individuals, including 41 pts with amyloidosis, 45 pts with HCM, 228 with HHD, 22 athletes and 33 healthy subjects
Summary
Left ventricular (LV) hypertrophy (LVH) can be part of an adaptation process in athletes; due to increased afterload in patients with hypertensive heart disease (HHD); Giusca et al J Cardiovasc Magn Reson (2021) 23:92 or an expression of myocyte hypertrophy and disarray in hypertrophic cardiomyopathy (HCM). Echocardiography provides accurate measurement of the LV mass and WT and, if required, myocardial strain, which were shown to aid the differential diagnosis of patients with LVH [2]. Cardiovascular magnetic resonance (CMR) on the other hand, allows for a multiparametric approach in the evaluation of patients with LVH, providing information on cardiac morphology, function, as well as tissue characterisation (T1 mapping) and the late gadolinium enhancement (LGE), all in one examination [4]. The incremental value of this sequence for the diagnosis and risk stratification of patients with different cardiac diseases has been recently reported [6]
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