Publicação
Study of myocardial deformation ascular magnetic resonance in patients with hypertrophic cardiomyopathy
| Resumo: | Background: Myocardial deformation assessment provides incremental diagnostic and prognostic value in various cardiovascular diseases. Feature tracking (FT) imaging has recently been proven as a reliable method to measure myocardial deformation from cardiac magnetic resonance (CMR). Aims: To investigate the diagnostic and prognostic value of CMR-FT deformation imaging in patients with hypertrophic cardiomyopathy (HCM). Methods and results: A total of 57 patients (pts) with HCM were consecutively and longitudinally studied genetically and clinically, including CMR. LV deformation analysis was retrospectively conducted using FT, comprising global peak systolic longitudinal (Ell), circumferential (Ecc) and radial (Err) strain. Ell, Ecc and Err strain were -13.7±4.8%,-16.6±5.2% and 32.5±12.8%, respectively. Fourteen patients (24.5%) had reduced Ell, 14 pts (24.5%) reduced Ecc and 17 pts (29.8%) reduced Err. Ell, Ecc and Err were significantly correlated with imaging markers of disease severity. Regional basal circumferential and radial strain showed a significant correlation with the ESC (European Society of Cardiology) HCM Risk-SCD score (r=0.34 and r=-0.32, respectively) (all p<0.05). Pts with non-sustained ventricular tachycardia (NSVT) showed worse basal and mid-ventricular circumferential (-14.4±4.7 vs -17.9±4.1% and -14.4±6.0 vs -19.2±5.1%, respectively) and radial (26.7±11.3 vs 35.3±12.4% and 23.6±12.5 vs 35.8±13.8%, respectively) strain (all p<0.05). A basal circumferential strain of -14.4% had a sensitivity of 0.75 and specificity of 0.81 to predict the presence of NSVT (AUC 0.745, p=0.013). Atrial fibrillation was more prevalent in pts with reduced Ell (27.3% vs 3.1%, p=0.017). The presence of late gadolinium enhancement was associated with reduced Ecc (92.9% vs 64.1%, p=0.04). The presence of a sarcomere gene mutation was associated with worse Ell (-12.2±5.6 vs -15.0±4.0%), Ecc (-13.3±4.4 vs -18.2±4.7%) and Err (23.9±9.4 vs 36.5±13.6%) (all p<0.05). Conclusions: Assessment of strain with CMT-FT is feasible and provides incremental diagnostic value. Additionally, worse deformation as assessed with CMR was associated with: a) imaging markers of disease severity; b) clinically relevant arrhythmic end-points; c) HCM Risk-SCD score; d) presence of sarcomere gene mutations. |
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| Autores principais: | O’Neill, Catarina Martins |
| Assunto: | Miocardiopatia hipertrófica Ressonância magnética cardíaca Cardiologia |
| Ano: | 2017 |
| País: | Portugal |
| Tipo de documento: | dissertação de mestrado |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Universidade de Lisboa |
| Idioma: | inglês |
| Origem: | Repositório da Universidade de Lisboa |
| Resumo: | Background: Myocardial deformation assessment provides incremental diagnostic and prognostic value in various cardiovascular diseases. Feature tracking (FT) imaging has recently been proven as a reliable method to measure myocardial deformation from cardiac magnetic resonance (CMR). Aims: To investigate the diagnostic and prognostic value of CMR-FT deformation imaging in patients with hypertrophic cardiomyopathy (HCM). Methods and results: A total of 57 patients (pts) with HCM were consecutively and longitudinally studied genetically and clinically, including CMR. LV deformation analysis was retrospectively conducted using FT, comprising global peak systolic longitudinal (Ell), circumferential (Ecc) and radial (Err) strain. Ell, Ecc and Err strain were -13.7±4.8%,-16.6±5.2% and 32.5±12.8%, respectively. Fourteen patients (24.5%) had reduced Ell, 14 pts (24.5%) reduced Ecc and 17 pts (29.8%) reduced Err. Ell, Ecc and Err were significantly correlated with imaging markers of disease severity. Regional basal circumferential and radial strain showed a significant correlation with the ESC (European Society of Cardiology) HCM Risk-SCD score (r=0.34 and r=-0.32, respectively) (all p<0.05). Pts with non-sustained ventricular tachycardia (NSVT) showed worse basal and mid-ventricular circumferential (-14.4±4.7 vs -17.9±4.1% and -14.4±6.0 vs -19.2±5.1%, respectively) and radial (26.7±11.3 vs 35.3±12.4% and 23.6±12.5 vs 35.8±13.8%, respectively) strain (all p<0.05). A basal circumferential strain of -14.4% had a sensitivity of 0.75 and specificity of 0.81 to predict the presence of NSVT (AUC 0.745, p=0.013). Atrial fibrillation was more prevalent in pts with reduced Ell (27.3% vs 3.1%, p=0.017). The presence of late gadolinium enhancement was associated with reduced Ecc (92.9% vs 64.1%, p=0.04). The presence of a sarcomere gene mutation was associated with worse Ell (-12.2±5.6 vs -15.0±4.0%), Ecc (-13.3±4.4 vs -18.2±4.7%) and Err (23.9±9.4 vs 36.5±13.6%) (all p<0.05). Conclusions: Assessment of strain with CMT-FT is feasible and provides incremental diagnostic value. Additionally, worse deformation as assessed with CMR was associated with: a) imaging markers of disease severity; b) clinically relevant arrhythmic end-points; c) HCM Risk-SCD score; d) presence of sarcomere gene mutations. |
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