The value of myocardial deformation analysis based on deformable registration algorithm in the diagnosis and prediction of prognosis of hypertrophic cardiomyopathy

doi:10.16150/j.1671-2870.2019.03.007

Abstract

Abstract:

Objective: To explore the value of myocardial strain analysis based on deformable registration algorithm (DRA) in the diagnosis of hypertrophic cardiomyopathy (HCM) and its relationship with prognostic risk factors. Methods: Twenty- three patients who were diagnosed as HCM in our hospital with (50.70±14.80) years old were collected retrospectively.In addition, 23 volunteers who matched the age and sex were also recruited. All volunteers underwent a cardiac MRI (CMR) scan consistent with the patients with HCM. According to the presence or absence of late gadolinium enhancement (LGE), the HCM group was divided into non-enhanced [LGE(-)] subgroup andenhanced [LGE(+)] subgroup.Images of patients with HCM and volunteers were analyzed using the DRA-based myocardial deformation post-processing software named TrufiStrain. The measurement parameters includedglobal peak radial strain (GPRS), global peak circumferential strain (GPCS), global peak longitudinal strain (GPLS), and peak radial, circumferential and longitudinal strain(PRS, PCS, and PLS) of different parts of the left ventricle (the apex, the middle of left ventricle, and the base). Student-t test or Mann-Whitney, Pearson correlation analysis, ROC curve were used to statistically analyze the diagnostic efficacy of myocardial deformation parameters in HCM and its relationship with left ventricular wall thickness and LGE. Results: Other than apical PCS, all GPRS, GPCS, GPLS, basal and medial PRS, PCS, PLS, and apical PRS, PLS in patients with HCM were significantly lower than those in healthy volunteers (P<0.05). The global, apical, basal and medial radial, circumferential and longitudinal strain and strain rate of the patients with HCM were significantly smaller than those of the control group (P<0.05). The basal and medial PRS, PCS, PLS of both the control group and the LGE(-) subgroup were significantly higher than those in LGE (+) subgroup (P<0.05). The ratio of radialstrain rate during early and late diastole (REL）, circumferentialstrain rate during early and late diastole (CEL) and longitudinal strain rate during early and late diastole (LEL) of patients in LGE (+) subgroup were smaller than those in LGE(-) subgroup and the control group (P<0.05). GPRS, GPCS, GPLS, REL, CEL and LEL were all significantly correlated with the maximum thickness of left ventricular myocardium (P<0.05). ROC curve analysis showed that areas under the curve of GPRS, GPCS, GPLS, REL, CEL and LEL for the diagnosis of HCM were 0.686, 0.905, 0.921, 0.972, 0.974 and 0.917, respectively. The areas under the curve of GPRS, GPCS, GPLS, REL, CEL and LEL for predicting LGE in patients with HCM were greater than 0.871. Conclusions: DRA-based myocardial deformation analysis is of great value in diagnosing HCM and predicting LGE in HCM patients and is closely correlated to myocardial thickness.

Key words: Deformableregistration algorithms, Myocardialstrainimaging, Hypertrophic Cardiomyopathy, Late Gadolinium Enhancement

CLC Number:

R445.4

ZHU Lan, GU Shengjia, CHEN Chihua, CAO Qiqi, ZHOU Xiaoyue, YAN Fuhua, MIN Jihua. The value of myocardial deformation analysis based on deformable registration algorithm in the diagnosis and prediction of prognosis of hypertrophic cardiomyopathy[J]. Journal of Diagnostics Concepts & Practice, 2019, 18(03): 278-285.

Figures/Tables 9

References 26

[1]	Maron BJ, Maron MS. Hypertrophic cardiomyopathy[J]. Lancet, 2013, 381(9862):242-255. doi: 10.1016/S0140-6736(12)60397-3 URL
[2]	Maron BJ. Hypertrophic cardiomyopathy: a systematic review[J]. JAMA, 2002, 287(10):1308-1320.
[3]	Basso C, Thiene G, Corrado D, et al. Hypertrophic cardiomyopathy and sudden death in the young: pathologic evidence of myocardial ischemia[J]. Hum Pathol, 2000, 31(8):988-998. pmid: 10987261
[4]	Gersh BJ, Maron BJ, Bonow RO, et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J]. J Am Coll Cardiol, 2011, 58(25):2703-2738. doi: 10.1016/j.jacc.2011.10.825 URL
[5]	Authors/Task Force members, Elliott PM, Anastasakis A, et al. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC)[J]. Eur Heart J, 2014, 35(39):2733-2779. doi: 10.1093/eurheartj/ehu284 pmid: 25173338
[6]	Ismail TF, Jabbour A, Gulati A, et al. Role of late gadolinium enhancement cardiovascular magnetic resonance in the risk stratification of hypertrophic cardiomyo-pathy[J]. Heart, 2014, 100(23):1851-1858. doi: 10.1136/heartjnl-2013-305471 URL
[7]	王辉, 晏子旭, 姜红, 等. 心脏磁共振应变分析在临床前期心尖肥厚型心肌病中的应用[J]. 中国医学影像学杂志, 2019, 27(1):1-5.
[8]	李雪莲, 黄为, 高见书, 等. 延迟增强磁共振成像预测肥厚型心肌病心肌纤维化与不良终点事件相关性的Meta分析[J]. 临床放射学杂志, 2018, 37(11):1824-1829.
[9]	李元程, 王杰, 陈玉成. 肥厚型心肌病基因型与磁共振表型的关联性研究进展[J]. 心血管病学进展, 2019, 40(2):157-161.
[10]	桑银保. 磁共振成像对肥厚性心肌病诊断及临床意义的探讨研究[J]. 大家健康(下旬版), 2015, 9(9):71-72.
[11]	O'Hanlon R, Grasso A, Roughton M, et al. Prognostic significance of myocardial fibrosis in hypertrophic cardiomyopathy[J]. J Am Coll Cardiol, 2010, 56(11):867-874. doi: 10.1016/j.jacc.2010.05.010 pmid: 20688032
[12]	Kraigher-Krainer E, Shah AM, Gupta DK, et al. Impaired systolic function by strain imaging in heart failure with preserved ejection fraction[J]. J Am Coll Cardiol, 2014, 63(5):447-456. doi: 10.1016/j.jacc.2013.09.052 pmid: 24184245
[13]	Macron L, Redheuil A, Ashrafpoor G, et al. Global circumferential left ventricular strain impairment in hypertrophic cardiomyopathy: comparison to left ventricular hypertrophy and late gadolinium enhancement[J]. J of Cardiovasc Magn Reson, 2013, 15(S1).
[14]	Orwat S, Kempny A, Diller GP, et al. Cardiac magnetic resonance feature tracking: a novel method to assess myocardial strain. Comparison with echocardiographic speckle tracking in healthy volunteers and in patients with left ventricular hypertrophy[J]. Kardiol Pol, 2014, 72(4):363-371. doi: 10.5603/KP.a2013.0319 URL
[15]	Haland TF, Almaas VM, Hasselberg NE, et al. Strain echocardiography is related to fibrosis and ventricular arrhythmias in hypertrophic cardiomyopathy[J]. Eur Heart J Cardiovasc Imaging, 2016, 17(6):613-621. doi: 10.1093/ehjci/jew005 pmid: 26873460
[16]	Gao H, Allan A, McComb C, et al. Left ventricular strain and its pattern estimated from cine CMR and validation with DENSE[J]. Phys Med Biol, 2014, 59(13):3637-3656. doi: 10.1088/0031-9155/59/13/3637 URL
[17]	Wang J, Li W, Sun J, et al. Improved segmental myocardial strain reproducibility using deformable registration algorithms compared with feature tracking cardiac MRI and speckle tracking echocardiography[J]. J Magn Reson Imaging, 2018, 48(2):404-414. doi: 10.1002/jmri.25937 pmid: 29283466
[18]	Meng L, Lin K, Collins J, et al. Automated Description of Regional Left Ventricular Motion in Patients With Cardiac Amyloidosis: A Quantitative Study Using Heart Deformation Analysis[J]. Am J Roentgenol, 2017, 209(2):W57-W63.
[19]	陈炎, 陈亚蓓, 陶荣芳. 欧洲心脏病学会2014年肥厚性心肌病诊断管理指南要点介绍[J]. 中国实用内科杂志, 2015, 35(S1):170-172.
[20]	Nucifora G, Muser D, Gianfagna P, et al. Systolic and diastolic myocardial mechanics in hypertrophic cardiomyopathy and their link to the extent of hypertrophy, replacement fibrosis and interstitial fibrosis[J]. Int J Cardiovasc Imaging, 2015, 31(8):1603-1610. doi: 10.1007/s10554-015-0720-0 pmid: 26210792
[21]	Hinojar R, Fernández-Golfín C, González-Gómez A, et al. Prognostic implications of global myocardial mechanics in hypertrophic cardiomyopathy by cardiovascular magnetic resonance feature tracking. Relations to left ventricular hypertrophy and fibrosis[J]. Int J Cardiol, 2017, 249:467-472. doi: S0167-5273(17)30710-6 pmid: 29121751
[22]	Popescu BA, Ro?ca M. Imaging of myocardial fibrosis in hypertrophic cardiomyopathy: what is the gold standard?[J]. Heart, 2014, 100(8):605-606. doi: 10.1136/heartjnl-2013-305359 pmid: 24459293
[23]	Germans T, Rüssel IK, Gütte MJ, et al. How do hypertrophic cardiomyopathy mutations affect myocardial function in carriers with normal wall thickness? Assessment with cardiovascular magnetic resonance[J]. J Cardiovasc Magn Reson, 2010, 12:13. doi: 10.1186/1532-429X-12-13 URL
[24]	Kino A, Carr J, Bonow R, et al. Association of Left Ventricular Wall Thickness and Myocardial Fibrosis/Scar with Adverse Events in Hypertrophic Cardiomyopathy: Interaction of Maximal Wall Thickness and Late Gadolinium Enhancement by Cardiac Magnetic Resonance[C]. J Am College Cardiol, 2012, 59(13):.
[25]	Bogarapu S, Puchalski MD, Everitt MD, et al. Novel Cardiac Magnetic Resonance Feature Tracking (CMR-FT) Analysis for Detection of Myocardial Fibrosis in Pediatric Hypertrophic Cardiomyopathy[J]. Pediatr Cardiol, 2016, 37(4):663-673. doi: 10.1007/s00246-015-1329-8 URL
[26]	Reant P, Mirabel M, Lloyd G, et al. Global longitudinal strain is associated with heart failure outcomes in hypertrophic cardiomyopathy[J]. Heart, 2016, 102(10):741-747. doi: 10.1136/heartjnl-2015-308576 URL

分组	对照组	HCM组	P值
男性（n）	18（78.26%）	18（78.26%）	/
年龄（岁）	50.26±8.66	50.70±14.18	0.901
身高（cm）	167.65±4.42	166.57±7.15	0.539
体重（kg）	65.83±65.57	72.17±15.00	0.067
心率（次/分）	65.78±7.66	65.61±8.94	0.944
BSA（m²）	1.71±0.09	1.79±0.22	0.141
EDV（mL）	109.53±20.58	131.08±25.93	0.003
EDVI（mL/m²）	63.92±11.26	73.81±14.02	0.011
ESV（mL）	45.59±13.81	55.55±14.86	0.023
ESVI（mL/m²）	26.60±7.82	31.31±8.66	0.049
EDM（g）	82.08±17.62	195.57±87.64	<0.001
EDMI（g/m²）	47.73±8.88	109.74±17.54	<0.001
ESM（g）	82.63±18.73	194.78±16.89	<0.001
ESMI（g/m²）	48.02±9.40	109.15±16.38	<0.001
SV（mL）	63.94±9.09	75.53±16.17	0.004
LVEF（%）	59.06±6.25	58.00±7.86	0.614

部位	组别	径向应变		环向应变		纵向应变
部位	组别	峰值（%）	率比值	峰值（%）	率比值	峰值（%）	率比值
整体	对照组	29.08±5.87	3.42±0.67	-15.43±1.43	2.67±1.45	-12.92±1.85	2.28±0.55
	HCM组	23.77±10.14	1.73±0.55	-11.15±3.55	1.45±0.90	-8.16±4.34	1.18±0.54
	P值	0.037	<0.001	<0.001	<0.001	<0.001	<0.001
基底部	对照组	38.33±9.02	3.34±0.69	-17.15±2.53	2.78±0.76	-22.90±3.34	2.16±0.68
	HCM组	23.81±11.42	1.66±0.99	-11.88±3.60	1.67±1.36	-15.34±5.85	1.41±0.79
	P值	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001
中部	对照组	38.25±8.08	3.73±1.04	-16.64±2.37	3.51±1.18	-20.41±3.31	3.05±1.28
	HCM组	24.29±10.90	1.65±0.90	-11.70±4.86	1.65±1.39	-14.28±6.39	1.43±0.76
	P值	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001
心尖部	对照组	37.97±7.74	3.61±1.04	-17.45±2.49	3.15±1.25	-20.48±3.90	2.54±1.10
	HCM组	27.34±10.37	1.95±1.15	-15.11±6.93	1.98±1.44	-16.35±6.82	1.78±1.06
	P值	<0.001	<0.001	0.139	0.005	0.016	0.02

部位		LGE分组	例数（n）	径向应变（%）	P值	环向应变（%）		纵向应变（%）	P值
基底部	HCM组	+	16	18.44±8.37	<0.001^a)	-10.09±2.03	<0.001^a)	-13.61±4.17	<0.001^a)
		-	7	36.07±7.15	<0.001^b)	-15.98±3.00	<0.001^b)	-20.02±3.83	<0.001^b)
	对照组		23	38.33±9.02	0.538^c)	-17.15±2.53	0.310^c)	-22.90±3.34	0.080^c)
	P值			<0.001		<0.001		<0.001
中部	HCM组	+	16	18.86±5.99	<0.001^b)	-9.40±3.21	<0.001^a)	-13.26±5.66	0.003^a)
		-	7	36.70±9.35	<0.001^b)	-16.94±3.83	<0.001^b)	-19.35±3.13	<0.001^b)
	对照组		23	38.25±8.08	0.633^c)	-16.64±2.37	0.839^c)	-20.41±3.31	0.566^c)
	P值			0.002		<0.001		<0.001
心尖部	HCM组	+	10	17.5±5.22	<0.001^b)	-9.79±2.47	<0.001^a)	-10.41±3.57	<0.001^a)
		-	13	34.91±5.84	<0.001^b)	-19.2±6.45	<0.001^b)	-20.92±4.87	<0.001^b)
	对照组		23	37.97±7.74	0.118^c)	-16.28±5.28	0.215^c)	-20.48±3.90	0.772^c)
	P值			<0.001		<0.001		<0.001

部位	分组	LGE	例数	径向比值	P值	环向比值	P值	纵向比值	P值
基底部	HCM	+	16	1.13±0.47	<0.001^a)	0.90±0.49	<0.001^a)	0.98±0.36	<0.001^a)
		-	7	2.87±0.79	<0.001^b)	3.40±1.05	<0.001^b)	2.41±0.55	<0.001^b)
	对照组		23	3.73±1.04	0.155^c)	2.78±0.76	0.049^c)	2.16±0.68	0.317^c)
	P值			0.001		<0.001		<0.001
中部	HCM	+	16	1.17±0.49	<0.001^a)	0.96±0.58	<0.001^a)	1.03±0.39	0.004^a)
		-	7	2.75±0.56	<0.001^b)	3.23±1.44	<0.001^b)	2.36±0.54	<0.001^b)
	对照组		23	3.45±1.13	0.007^c)	3.51±1.18	0.896^c)	3.05±1.28	0.103^c)
	P值			<0.001		<0.001		<0.001
心尖部	HCM	+	10	1.13±0.36	<0.001^a)	2.59±1.15	<0.001^a)	3.61±1.04	<0.001^a)
		-	13	2.59±1.15	<0.001^b)	2.38±1.83	<0.001^b)	3.15±1.25	<0.001^b)
	对照组		23	3.61±1.04	0.008^c)	3.15±1.25	0.426^c)	2.54±1.10	0.817^c)
	P值			<0.001		<0.001		<0.001

部位	LGE	例数	心肌最大厚度（mm）	P值
基底部	LGE (+)	16	15.21±4.02	0.012
	LGE (-)	7	21.48±5.36
中部	LGE (+)	16	17.83±3.27	0.336
	LGE (-)	7	16.07±5.26
心尖部	LGE (+)	10	12.37±4.39	0.007
	LGE (-)	13	17.58±3.90