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Analysis of three-dimensional endocardial and epicardial strains from cardiac magnetic resonance in healthy subjects and patients with hypertrophic cardiomyopathy

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Abstract

Hypertrophic cardiomyopathy (HCM) is a genetic disease that leads to left ventricle (LV) hypertrophy with or without the presence of LV outflow tract obstruction. The aim of this study was to find an easy and useful indicator based on cardiac magnetic resonance (CMR) images for control subjects and patients with and without obstruction. CMR scans were performed for 19 control subjects and 19 HCM patients. Endocardial strain was defined as \(S_{\text{endo}} = \left| {{ \ln }\left( {\frac{{L_{{{\text{ES}},\,{\text{endo}}}} }}{{L_{{{\text{ED}},\,{\text{endo}}}} }}} \right)} \right| \times 100\%\), with \(L_{{{\text{ED}},\,{\text{endo}}}} \left( {L_{{{\text{ES}},\,{\text{endo}}}} } \right)\) being the length of endocardium at end-diastole (end-systole); similarly for epicardial strain (\(S_{\text{epi}}\)). The strains were evaluated in cine CMR two-, three- and four-chamber views. Six atrioventricular junction (AVJ) points from three CMR views were semi-automatically tracked. The peak systolic velocity (Sm1), peak early diastolic velocity and late diastolic velocity (Em, Am) were extracted and analysed. Compared with control subjects, HCM patients had significantly smaller three-dimensional strains and AVJ motion incorporating measurements from three long-axis views (all P < 0.05). Moreover, ROC analysis found that three-dimensional global epicardial strain <17.2% had the best sensitivity 94.4% and specificity 94.7% to differentiate HCM from control (AUC = 0.97). Therefore, three-dimensional endocardial and epicardial strains provide an easy and effective approach to manage and triage hypertrophic cardiomyopathy patients.

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Acknowledgements

This work has been partially supported by National Medical Research Council through Project (Grant Number NMRC/OFIRG/0018/2016) and (Grant Number NMRC/EDG/1037/2011). This research was also supported by Biomedical Research Council through research Grant (14/1/32/24/002).

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Authors and Affiliations

  1. National Heart Centre Singapore, Singapore, Singapore

    Xiaodan Zhao, Ru San Tan, Hak Chiaw Tang, Shuang Leng, Jun-Mei Zhang & Liang Zhong

  2. Duke-NUS Medical School, Singapore, Singapore

    Ru San Tan & Liang Zhong

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  1. Xiaodan Zhao
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  2. Ru San Tan
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  4. Shuang Leng
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Correspondence to Liang Zhong.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Zhao, X., Tan, R.S., Tang, H.C. et al. Analysis of three-dimensional endocardial and epicardial strains from cardiac magnetic resonance in healthy subjects and patients with hypertrophic cardiomyopathy. Med Biol Eng Comput 56, 159–172 (2018). https://doi.org/10.1007/s11517-017-1674-2

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