LGE-CMR-derived texture features reflect poor prognosis in hypertrophic cardiomyopathy patients with systolic dysfunction: preliminary results
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To evaluate the prognostic value of texture features based on late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) images in hypertrophic cardiomyopathy (HCM) patients with systolic dysfunction.
67 HCM patients with systolic dysfunction (41 male and 26 female, mean age ± standard deviation, 46.20 years ± 13.38) were enrolled. All patients underwent 1.5 T CMR cine and LGE imaging. Texture features were extracted from LGE images. Cox proportional hazard analysis and Kaplan-Meier analysis were used to determine the association of texture features and traditional parameters with event free survival.
Family history (hazard ratio [HR]=2.558, 95 % confidence interval [CI]=1.060–6.180), NYHA III-IV (HR=5.627, CI=1.652–19.173), left ventricular ejection fraction (HR=0.945, CI=0.902–0.991), left ventricular end-diastolic volume index (HR=1.006, CI=1.000–1.012), LGE extent (HR=1.911, CI=1.348–2.709) and three texture parameters [X0_H_skewness (HR=0.783, CI=0.691–0.889), X0_GLCM_cluster_tendency (HR=0.735, CI=0.616–0.877) and X0_GLRLM_energy (HR=1.344, CI=1.173–1.540)] were significantly associated with event free survival in univariate analysis (p<0.05). The HR of LGE extent (HR=1.548 [CI=1.046–2.293], 1.650 [CI=1.122–2.428] and 1.586 [CI=1.044–2.409] per 10 % increase, p<0.05) remained significant when adjusted by one of the three texture features.
Increased LGE heterogeneity (higher X0_GLRLM_energy, lower X0_H_skewness and lower X0_GLCM_cluster_tendency) was associated with adverse events in HCM patients with systolic dysfunction.
• Textural analysis from CMR can be applied in HCM.
• Texture features derived from LGE images can capture fibrosis heterogeneity.
• CMR texture analysis provides prognostic information in HCM patients.
KeywordsHypertrophic cardiomyopathy Cardiac magnetic resonance Late gadolinium enhancement Texture features Event-free survival
Abbreviations and acronyms
Cardiac magnetic resonance
Cardiac resynchronization therapy defibrillator
Grey-level co-occurrence matrix
Grey-level run-length matrix
Intra-/inter-class correlation coefficient
Implantable cardioverter defibrillator
Late gadolinium enhancement
Left ventricular ejection fraction
New York Heart Association
Receiver operating characteristic
Region of interest
Sudden cardiac death
The study was supported by the major international (regional) joint research project of National Science Foundation of China (No.81620108015), Capital Characteristic and Clinical Application Research Fund from the Beijing Municipal Commission of Science and Technology (No.Z161100000516110), National Natural Science Foundation of China (No. 81771924, 61231004, 81501616, 81301346, 81501549, 81527805 and 81671851), Science and Technology Service Network Initiative of the Chinese Academy of Sciences (No.KFJ-SW-STS-160), Key Research Program of the Chinese Academy of Sciences (No.KGZD-EW-T03), Instrument Developing Project (No.YZ201502), Strategic Priority Research Program (B) of the CAS (No.XDB02060010), Beijing Municipal Science and Technology Commission (No.Z161100002616022) and the Youth Innovation Promotion Association CAS.
Compliance with ethical standards
The scientific guarantor of this publication is Dr. Shihua Zhao.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
Di Dong and Mengjie Fang have significant statistical expertise.
Written informed consent was waived by the Institutional Review Board because of the retrospective nature.
Institutional Review Board approval was obtained.
• diagnostic or prognostic study
• performed at one institution
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