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Novel Cardiac Magnetic Resonance Feature Tracking (CMR-FT) Analysis for Detection of Myocardial Fibrosis in Pediatric Hypertrophic Cardiomyopathy

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Abstract

Myocardial fibrosis is a risk factor for sudden cardiac death in hypertrophic cardiomyopathy (HCM) and is conventionally identified by cardiac magnetic resonance imaging (CMR) using late gadolinium enhancement (LGE). This study evaluates utility of a novel 16-segment CMR feature tracking (CMR-FT) technique for measuring left ventricular (LV) strain (S) and strain rate (SR) on non-contrast cine images to detect myocardial fibrosis in pediatric HCM. We hypothesized that CMR-FT-derived S and SR will accurately differentiate HCM patients with and without myocardial fibrosis. Consecutive children with HCM who underwent CMR with LGE at our institution from 2006 to 2014 were included. Global and regional longitudinal, radial and circumferential S and SR of the LV in 2D and 3D were obtained using a CMR-FT software. Comparisons were made between HCM patients with (+LGE) and without (−LGE) delayed enhancement. Of the 29 HCM patients (mean age 13.5 ± 6.1 years; 52 % males), 11 (40 %) patients (mean age 17.5 ± 8.4 years) had +LGE. Global longitudinal, circumferential and radial S and SR were lower in +LGE compared to −LGE patients, in both 2D and 3D. Regional analysis revealed lower segmental S and SR in the septum with fibrosis compared to free wall without fibrosis. A global longitudinal S of ≤ −12.8 had 91 % sensitivity and 89 % specificity for detection of LGE. In pediatric HCM patients with myocardial fibrosis, global LV longitudinal, circumferential and radial S and SR were reduced, specifically in areas of fibrosis. A global longitudinal S of ≤ −12.8 detected patients with fibrosis with high degree of accuracy. This novel CMR-FT technique may be useful to identify myocardial fibrosis and risk-stratify pediatric HCM without use of contrast agents.

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Abbreviations

CMR:

Cardiac magnetic resonance

FT:

Feature tracking

HCM:

Hypertrophic cardiomyopathy

LGE:

Late gadolinium enhancement

LV:

Left ventricle

SCD:

Sudden cardiac death

SSFP:

Steady-state free precession

S:

Peak systolic strain

SR:

Peak systolic strain rate

TDI:

Tissue Doppler imaging

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Acknowledgments

This investigation was supported by the University of Utah Study Design and Biostatistics Center, with funding in part from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant 8UL1TR000105 (formerly UL1RR025764).

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Authors and Affiliations

  1. Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, 81 N Mario Capecchi Drive, Salt Lake City, UT, 84113, USA

    Soujanya Bogarapu, Michael D. Puchalski, Richard V. Williams & Shaji C. Menon

  2. Division of Pediatric Cardiology, Children’s Hospital Colorado, Aurora, CO, USA

    Melanie D. Everitt

  3. Study Design and Biostatistics Center, University of Utah School of Medicine, Salt Lake City, UT, USA

    Hsin-Yi Weng

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  1. Soujanya Bogarapu
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  2. Michael D. Puchalski
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  3. Melanie D. Everitt
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Correspondence to Shaji C. Menon.

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Bogarapu, S., Puchalski, M.D., Everitt, M.D. et al. Novel Cardiac Magnetic Resonance Feature Tracking (CMR-FT) Analysis for Detection of Myocardial Fibrosis in Pediatric Hypertrophic Cardiomyopathy. Pediatr Cardiol 37, 663–673 (2016). https://doi.org/10.1007/s00246-015-1329-8

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