Role of feature tracking cardiac MRI in evaluation of ischemic cardiomyopathy

Diffuse Fibrosis in Hypertrophic Cardiomyopathy: Incremental Prognostic Value of Extracellular Volume.

BACKGROUND Left ventricular (LV) myocardial extracellular volume (ECV), from cardiac magnetic resonance (CMR) T1 mapping, primarily reflects diffuse fibrosis and is a marker of adverse myocardial remodeling in hypertrophic cardiomyopathy (HCM). OBJECTIVES The authors sought to evaluate the prognostic value of ECV beyond established clinical and imaging variables in a large contemporary HCM cohort. METHODS We evaluated 1,050 consecutive patients with HCM and preserved LV ejection fraction (≥50%) who underwent CMR, including quantification of ECV (%) and late gadolinium enhancement (LGE) burden (% LV mass, >6 SDs above remote myocardium), between 2012 and 2021. The primary endpoint was a composite of mortality, appropriate implantable cardioverter-defibrillator (ICD) therapy, or heart transplantation. Statistical methods included multivariable Cox proportional hazards regression, restricted cubic spline analysis, assessment of incremental discrimination using changes in the C-statistic, and net reclassification improvement analysis. RESULTS Median age was 60 years (IQR: 49-68 years) with 44% women. Median follow-up was 5.6 years (IQR: 2.5-7.8 years). The primary endpoint occurred in 124 patients (11.8%), including 111 deaths (10.6%), 12 appropriate ICD discharges (1.1%), and 1 heart transplantation (0.1%). In multivariable Cox regression, older age (HR: 1.05, 95% CI: 1.03-1.06; P < 0.001), NYHA functional class ≥II (HR: 1.96, 95% CI: 1.23-3.11; P = 0.004), diabetes mellitus (HR: 1.89, 95% CI: 1.27-2.81; P = 0.002), and higher ECV (HR: 1.05 per 1% increase, 95% CI: 1.02-1.09; P = 0.001) were independently associated with the primary outcome. Patients with ECV ≥32% had lower event-free survival than those with ECV <32% (adjusted HR: 1.81, 95% CI: 1.24-2.64; P < 0.001). CONCLUSIONS Myocardial ECV was independently associated with long-term adverse outcomes. Multiparametric CMR assessment may improve risk stratification in HCM.

Relationships Between Regional Left Ventricular Myocardial Strain and Tissue Characteristics in Hypertrophic Cardiomyopathy

Both fibrosis and hypertrophy contribute to abnormal myocardial mechanics in hypertrophic cardiomyopathy (HCM). We sought to assess the relationships between regional structural and functional parameters in HCM by cardiac magnetic resonance (CMR). This was a retrospective single-center study of HCM patients and age-matched controls with either hypertensive heart disease (HHD) or normal CMRs. CMR feature tracking was performed to assess global and segmental 2D-radial, circumferential, and longitudinal LV strain, while native and post-contrast T1 parametric mapping analysis was performed to assess the global and regional T1 values and ECV fraction. Of 100 patients (age 56 ± 15 years; 66% male), 62 were in the HCM group and 38 in the control group (19 healthy individuals and 19 with HHD). Compared to the control group, global circumferential strain (−16.1 ± 5.9% vs. −20.8 ± 3.6%, p < 0.001) and radial strain (45.2 ± 14.1% vs. 32.1 ± 14.0%, p < 0.001) were worse in the HCM group. Among the HCM patients, there were significant correlations between segmental native T1 values at the most hypertrophied segment and global longitudinal strain (r = 0.27, p = 0.031), global circumferential strain (r = 0.34, p = 0.006), global radial strain (r = −0.29, p = 0.024), and left ventricular ejection fraction (LVEF) (r = −0.31, p = 0.014). In HCM, higher myocardial T1 at the most hypertrophied segment correlated with worse global LV myocardial strain and LVEF by CMR.

Prognostic Value of Strain Imaging Measurements in Patients with Non-ischemic Cardiomyopathy: A Scoping Review.

Strain parameters, particularly LVGLS, remained independently associated with outcomes in 34 of 36 studies after multivariable adjustment, often providing incremental value beyond LVEF and late gadolinium enhancement, and support strain imaging, especially LVGLS, as an adjunct to conventional risk stratification in diverse NICM populations.

Left ventricular myocardial strain analysis by feature tracking cardiac magnetic resonance in patients with autoimmune rheumatic diseases: A case-control study.

Patients with autoimmune rheumatic diseases exhibit subclinical left ventricular dysfunction despite preserved ejection fraction and absence of myocardial fibrosis on late gadolinium enhancement imaging, as well as significant reductions in circumferential and longitudinal strain rate parameters.

Usefulness of Strain Echocardiography in Heart Failure with Preserved Ejection Fraction

A multi-chamber strain-based approach may improve HFpEF diagnosis, phenotyping, and risk stratification, supporting a transition toward a more personalized management strategy.

Left ventricular systolic dysfunction detected by speckle tracking in hypertensive patients with preserved ejection fraction (cid:2)