Prognostic value of regional strain by cardiovascular magnetic resonance feature tracking in hypertrophic cardiomyopathy

Xiaorong Chen; Jiangfeng Pan; Jiner Shu; Xiaoru Zhang; Limei Ye; Lin Chen; Yi Hu; Risheng Yu

doi:10.21037/qims-21-42

Prognostic value of regional strain by cardiovascular magnetic resonance feature tracking in hypertrophic cardiomyopathy

Quant Imaging Med Surg. 2022 Jan;12(1):627-641. doi: 10.21037/qims-21-42.

Authors

Xiaorong Chen^#^{1

2}, Jiangfeng Pan^#¹, Jiner Shu³, Xiaoru Zhang¹, Limei Ye¹, Lin Chen¹, Yi Hu¹, Risheng Yu²

Affiliations

¹ Department of Medical Imaging, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China.
² Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
³ Department of Radiology, Jinhua People's Hospital, Jinhua, China.

^# Contributed equally.

Abstract

Background: Few studies have demonstrated the performance of regional strain by cardiovascular magnetic resonance (CMR) feature tracking in hypertrophic cardiomyopathy (HCM) patients, and the prognostic value of segmental strain remains unknown. This study aimed to explore the prognostic implications of strain parameters generated by CMR feature tracking analysis in HCM patients.

Methods: In total, 104 clinically diagnosed HCM patients and 30 healthy volunteers were enrolled in this study, and all patients underwent a standard CMR examination. Global and regional strain was computed by short axis, 2-, 3-, and 4-chamber view cine MR imaging using specialized software. Cardiac structure, function, and myocardial strain were compared between the control group and HCM patients, and the event and event-free groups. Univariate and multivariate Cox regression analyses were performed to evaluate the correlations between clinical and CMR parameters and poor prognosis.

Results: During the follow-up time, 8 patients reached the primary end points and 14 patients reached secondary end points. Regional radial strain of hypertrophic segments (RRS) and regional circumferential strain of hypertrophic segments (RCS) were worse in HCM patients with primary and secondary end points. In univariate Cox regression analysis of RRS, RCS were associated with primary and secondary end points. Regional radial strain of hypertrophic segments [hazard ratio (HR) 1.64, 95% confidence interval (CI): 1.13-2.38] and RCS (HR 2.35, 95% CI: 1.20-4.59) were independent predictors of primary end points, and RRS (HR 1.71, 95% CI: 1.09-2.66) and RCS (HR 2.63, 95% CI: 1.20-5.75) remained independent predictors of secondary end points in multivariate analysis. Kaplan-Meier survival curves indicated patients with RRS <10.0% and RCS ≥-8.5% had a higher rate of primary end points, and patients with RRS <17.9% and RCS ≥-12.1% experienced a higher rate of secondary end points.

Conclusions: In HCM patients, RRS and RCS were associated with primary and secondary end points and remained independent predictors in multivariate analysis. Impaired regional strain may potentially predict poor prognosis in HCM patients.

Keywords: Prognosis; hypertrophic cardiomyopathy (HCM); cardiovascular magnetic resonance (CMR); regional strain.