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Zhong Y, Li C, Yu Y, Du Y, Bai Y, Wang X, Dai X, Fan G, Wang G. Evaluation the relationship between myocardial fibrosis and left ventricular torsion measured by cardiac magnetic resonance feature-tracking in hypertrophic cardiomyopathy patients with preserved ejection fraction. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03061-7. [PMID: 38448705 DOI: 10.1007/s10554-024-03061-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/03/2024] [Indexed: 03/08/2024]
Abstract
The relationship between left ventricular (LV) torsion and myocardial fibrosis (MF) in hypertrophic cardiomyopathy (HCM) patients with preserved ejection fraction was still not well understood. New developments in cardiac magnetic resonance (CMR) enable a much fuller assessment of cardiac characteristics. This study sought to assess the impact of HCM on myocardial function as assessed by LV torsion and its relationship with MF. HCM (n = 79) and healthy controls (n = 40) underwent CMR. According to whether there was late gadolinium enhancement (LGE), patients were divided into LGE+ group and LGE- group. LV torsion and torsion rate were measured by CMR feature-tracking (CMR-FT). MF was quantitatively evaluated through LGE imaging. LGE was present in 44 patients (56%). Compared with healthy controls, torsion increased in the LGE- group (P < 0.001). Compared with LGE+ group, torsion was higher in the LGE- group (P < 0.001). There was no significant difference in torsion between LGE+ group and healthy controls. Correlation analysis showed that torsion was correlated with LGE% (r = - 0.443) and LGE mass (r = - 0.435) respectively. On multivariable logistic regression analysis, LV torsion was the only feature that was independently associated with the presence of LGE (OR 0.130; 95% CI 0.040 to 0.420, P = 0.01). The best torsion value associated with MF was 1.91 (sensitivity 60.0%, specificity 77.3%, AUC = 0.733). In HCM patients with preserved ejection fraction, CMR-FT derived LV torsion analysis holds promise for myocardial fibrosis detection.
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Affiliation(s)
- Ying Zhong
- Department of Radiology, The First Hospital of China Medical University, No.155, North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Ce Li
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Yang Yu
- Department of Cardio-surgery, The First Hospital of China Medical University, Shenyang, China
| | - Yaqi Du
- Department of Radiology, The First Hospital of China Medical University, No.155, North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Yun Bai
- Department of Radiology, The First Hospital of China Medical University, No.155, North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Xinrui Wang
- Department of Radiology, The First Hospital of China Medical University, No.155, North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Xu Dai
- Department of Radiology, The First Hospital of China Medical University, No.155, North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Guoguang Fan
- Department of Radiology, The First Hospital of China Medical University, No.155, North Nanjing Street, Shenyang, 110001, Liaoning, China.
| | - Guan Wang
- Department of Radiology, The First Hospital of China Medical University, No.155, North Nanjing Street, Shenyang, 110001, Liaoning, China.
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Gudigar A, Raghavendra U, Samanth J, Dharmik C, Gangavarapu MR, Nayak K, Ciaccio EJ, Tan RS, Molinari F, Acharya UR. Novel Hypertrophic Cardiomyopathy Diagnosis Index Using Deep Features and Local Directional Pattern Techniques. J Imaging 2022; 8:jimaging8040102. [PMID: 35448229 PMCID: PMC9030738 DOI: 10.3390/jimaging8040102] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 02/04/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a genetic disorder that exhibits a wide spectrum of clinical presentations, including sudden death. Early diagnosis and intervention may avert the latter. Left ventricular hypertrophy on heart imaging is an important diagnostic criterion for HCM, and the most common imaging modality is heart ultrasound (US). The US is operator-dependent, and its interpretation is subject to human error and variability. We proposed an automated computer-aided diagnostic tool to discriminate HCM from healthy subjects on US images. We used a local directional pattern and the ResNet-50 pretrained network to classify heart US images acquired from 62 known HCM patients and 101 healthy subjects. Deep features were ranked using Student’s t-test, and the most significant feature (SigFea) was identified. An integrated index derived from the simulation was defined as 100·log10(SigFea/2) in each subject, and a diagnostic threshold value was empirically calculated as the mean of the minimum and maximum integrated indices among HCM and healthy subjects, respectively. An integrated index above a threshold of 0.5 separated HCM from healthy subjects with 100% accuracy in our test dataset.
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Affiliation(s)
- Anjan Gudigar
- Department of Instrumentation and Control Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, India; (A.G.); (C.D.); (M.R.G.)
| | - U. Raghavendra
- Department of Instrumentation and Control Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, India; (A.G.); (C.D.); (M.R.G.)
- Correspondence:
| | - Jyothi Samanth
- Department of Cardiovascular Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal 576104, India; (J.S.); (K.N.)
| | - Chinmay Dharmik
- Department of Instrumentation and Control Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, India; (A.G.); (C.D.); (M.R.G.)
| | - Mokshagna Rohit Gangavarapu
- Department of Instrumentation and Control Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, India; (A.G.); (C.D.); (M.R.G.)
| | - Krishnananda Nayak
- Department of Cardiovascular Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal 576104, India; (J.S.); (K.N.)
| | - Edward J. Ciaccio
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY 10032, USA;
| | - Ru-San Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore 169609, Singapore;
- Duke-NUS Medical School, Singapore 169857, Singapore
| | - Filippo Molinari
- Department of Electronics and Telecommunications, Politecnico di Torino, 10129 Torino, Italy;
| | - U. Rajendra Acharya
- School of Engineering, Ngee Ann Polytechnic, Clementi, Singapore 599489, Singapore;
- Department of Biomedical Informatics and Medical Engineering, Asia University, Taichung 41354, Taiwan
- International Research Organization for Advanced Science and Technology (IROAST), Kumamoto University, Kumamoto 8608555, Japan
- Department of Biomedical Engineering, School of Science and Technology, SUSS University, Singapore 599494, Singapore
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Critical Evaluation of Current Hypotheses for the Pathogenesis of Hypertrophic Cardiomyopathy. Int J Mol Sci 2022; 23:ijms23042195. [PMID: 35216312 PMCID: PMC8880276 DOI: 10.3390/ijms23042195] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/07/2022] [Accepted: 02/14/2022] [Indexed: 02/04/2023] Open
Abstract
Hereditary hypertrophic cardiomyopathy (HCM), due to mutations in sarcomere proteins, occurs in more than 1/500 individuals and is the leading cause of sudden cardiac death in young people. The clinical course exhibits appreciable variability. However, typically, heart morphology and function are normal at birth, with pathological remodeling developing over years to decades, leading to a phenotype characterized by asymmetric ventricular hypertrophy, scattered fibrosis and myofibrillar/cellular disarray with ultimate mechanical heart failure and/or severe arrhythmias. The identity of the primary mutation-induced changes in sarcomere function and how they trigger debilitating remodeling are poorly understood. Support for the importance of mutation-induced hypercontractility, e.g., increased calcium sensitivity and/or increased power output, has been strengthened in recent years. However, other ideas that mutation-induced hypocontractility or non-uniformities with contractile instabilities, instead, constitute primary triggers cannot yet be discarded. Here, we review evidence for and criticism against the mentioned hypotheses. In this process, we find support for previous ideas that inefficient energy usage and a blunted Frank–Starling mechanism have central roles in pathogenesis, although presumably representing effects secondary to the primary mutation-induced changes. While first trying to reconcile apparently diverging evidence for the different hypotheses in one unified model, we also identify key remaining questions and suggest how experimental systems that are built around isolated primarily expressed proteins could be useful.
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Lopez-Candales A, Hernandez-Suarez DF. Strain Imaging Echocardiography: What Imaging Cardiologists Should Know. Curr Cardiol Rev 2017; 13:118-129. [PMID: 27799029 PMCID: PMC5452148 DOI: 10.2174/1573403x12666161028122649] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/06/2016] [Accepted: 10/18/2016] [Indexed: 01/30/2023] Open
Abstract
Despite recent advances in clinical imaging, echocardiography remains as the most accessi-ble and reliable noninvasive. Since knowledge of left ventricular systolic function remains so critically important in determining prognosis; every effort should be made to prevent subjective estimations. The advent of strain imaging echocardiography now offers a readily available and portable imaging tool that not only offers an objective characterization of myocardial dynamics; but also allows for early detection of subclinical left ventricular dysfunction. This review outlines the basic concepts of strain imaging to better understand the mechanism of myocardial function as well their applicability in the least common cardiac diagnosis among current clinical practice.
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Affiliation(s)
- Angel Lopez-Candales
- Cardiovascular Medicine Division, University of Puerto Rico School of Medicine, Medical Sciences Building, PO Box 365067, San Juan, Puerto Rico
| | - Dagmar F Hernandez-Suarez
- Cardiovascular Medicine Division, University of Puerto Rico School of Medicine, Medical Sciences Building, PO Box 365067, San Juan, Puerto Rico
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Pantazis A, Vischer AS, Perez-Tome MC, Castelletti S. Diagnosis and management of hypertrophic cardiomyopathy. Echo Res Pract 2015; 2:R45-53. [PMID: 26693331 PMCID: PMC4676455 DOI: 10.1530/erp-15-0007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 03/11/2015] [Indexed: 12/29/2022] Open
Abstract
The clinical spectrum of hypertrophic cardiomyopathy (HCM) is complex and includes a variety of phenotypes, which leads to different types of manifestations. Although most of the patients are asymptomatic, a significant proportion of them will develop symptoms or risk of arrhythmias and sudden cardiac death (SCD). Therefore, the objectives of HCM diagnosis and management are to relieve the patients' symptoms (chest pain, heart failure, syncope, palpitations, etc.), prevent disease progression and major cardiovascular complications and SCD. The heterogeneity of HCM patterns, their symptoms and assessment is a challenge for the cardiologist.
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Affiliation(s)
- Antonis Pantazis
- The Heart Hospital , 16-18 Westmoreland Street, London, W1G 8PH , UK
| | - Annina S Vischer
- The Heart Hospital , 16-18 Westmoreland Street, London, W1G 8PH , UK
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