Cardiac Magnetic Resonance (CMR) is considered a reference standard diagnostic tool for the evaluation of cardiomyopathy, and is frequently used to differentiate cause of left ventricular hypertrophy (LVH). The capacity to differentiate etiology based upon myocardial deformation alone is particularly attractive when contrast is contraindicated. 3-dimensional (3D) feature tracking allows for spatial mapping of both conventional (radial, circumferential and longitudinal) and principal strain markers from routine, non-contrast 2D cine images. In this study, we investigated the potential of this analysis approach to differentiate the cause of LVH in patients with confirmed cardiomyopathies associated with Left Ventricular Hypertrophy (LVH): Hypertrophic cardiomyopathy (HCM), Fabry cardiomyopathy, and cardiac amyloidosis (CA). Forty-five subjects were recruited with confirmed LVH and a known cardiomyopathy state (HCM, N=15; Fabry, N=15; Cardiac Amyloid, N=15). All cardiomyopathy states were confirmed by published CMR criteria (HCM and CA) and/or genetic testing (Fabry and HCM). CMR imaging was performed at 3T using a standardized protocol inclusive of multi-planar cine imaging. LV ejection fraction (LVEF) was quantified using commercially available software (cvi42, Circle Cardiovascular Imaging Inc.). 3D strain analysis was performed using custom in-house software (GIUSEPPE) with generation of endocardial, epicardial and transmural spatial strain maps using a dynamic 3D mesh model. Principal component analysis was performed (Matlab, MathWorks) on the amplitude of peak-systolic strain obtained in all AHA segments in both conventional (longitudinal, circumferential, radial) and principal directions. The mean age was 57.9±15.2 years with 17 (37%) female. The respective LVEFs were 57.9±13.6%, 69.1±6.1%, and 69.5±9.8% among CA, Fabry’s, and HCM, respectively. 3D strain distributions were successfully computed for all patients. Segmental strain amplitude measures were subjected to principal component analysis. The first and second principal components of the regional strain data were used as a diagnostic marker by means of a Naive Bayes classifier. Both the posterior predictive distribution and the classification probability were visualized (Figure 1), showing capacity for disease state discrimination. The confusion matrix revealed an overall accuracy of 0.80, with true positive rates of 0.73 for CA, 0.8 for Fabry’s, and 0.67 for HCM. The concomitant evaluation of regional values of systolic strain amplitude in multiple directions was able to correctly classify patients by disease, based on the exclusive knowledge of regional strain amplitude patterns. These results offer strong promise for the use of 3D strain analysis to assist in the diagnosis of cardiomyopathy state among patients with LVH.
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