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Tissue characterisation and myocardial mechanics using cardiac MRI in children with hypertrophic cardiomyopathy

Published online by Cambridge University Press:  26 November 2019

Sudeep Sunthankar ,
David A. Parra ,
Kristen George-Durrett ,
Kimberly Crum ,
Joshua D. Chew ,
Jason Christensen ,
Frank J. Raucci Jr ,
Meng Xu ,
James C. Slaughter  and
Jonathan H. Soslow Open the ORCID record for Jonathan H. Soslow [Opens in a new window]
Sudeep Sunthankar
Affiliation:
Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
David A. Parra
Affiliation:
Thomas P Graham Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
Kristen George-Durrett
Affiliation:
Thomas P Graham Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
Kimberly Crum
Affiliation:
Thomas P Graham Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
Joshua D. Chew
Affiliation:
Thomas P Graham Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
Jason Christensen
Affiliation:
Thomas P Graham Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
Frank J. Raucci Jr
Affiliation:
Thomas P Graham Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
Meng Xu
Affiliation:
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
James C. Slaughter
Affiliation:
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
Jonathan H. Soslow*
Affiliation:
Thomas P Graham Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
*
Author for correspondence: Jonathan H. Soslow, MD, MSCI, Assistant Professor, Pediatrics, Thomas P. Graham, Jr. Division of Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, 2200 Children’s Way, Suite 5230, Doctors’ Office Tower, Nashville, TN 37232-9119, USA. Phone: +1 615 322 7447; Fax: +1 615 322 2210; E-mail: [email protected]
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Abstract

Introduction:

Distinguishing between hypertrophic cardiomyopathy and other causes ofleft ventricular hypertrophy can be difficult in children. We hypothesised that cardiac MRI T1 mapping could improve diagnosis of paediatric hypertrophic cardiomyopathy and that measures of myocardial function would correlate with T1 times and extracellular volume fraction.

Methods:

Thirty patients with hypertrophic cardiomyopathy completed MRI with tissue tagging, T1-mapping, and late gadolinium enhancement. Left ventricular circumferential strain was calculated from tagged images. T1, partition coefficient, and synthetic extracellular volume were measured at base, mid, apex, and thickest area of myocardial hypertrophy. MRI measures compared to cohort of 19 healthy children and young adults. Mann–Whitney U, Spearman’s rho, and multivariable logistic regression were used for statistical analysis.

Results:

Hypertrophic cardiomyopathy patients had increased left ventricular ejection fraction and indexed mass. Hypertrophic cardiomyopathy patients had decreased global strain and increased native T1 (−14.3% interquartile range [−16.0, −12.1] versus −17.3% [−19.0, −15.7], p < 0.001 and 1015 ms [991, 1026] versus 990 ms [972, 1001], p = 0.019). Partition coefficient and synthetic extracellular volume were not increased in hypertrophic cardiomyopathy. Global native T1 correlated inversely with ejection fraction (ρ = −0.63, p = 0.002) and directly with global strain (ρ = 0.51, p = 0.019). A logistic regression model using ejection fraction and native T1 distinguished between hypertrophic cardiomyopathy and control with an area under the receiver operating characteristic curve of 0.91.

Conclusion:

In this cohort of paediatric hypertrophic cardiomyopathy, strain was decreased and native T1 was increased compared with controls. Native T1 correlated with both ejection fraction and strain, and a model using native T1 and ejection fraction differentiated patients with and without hypertrophic cardiomyopathy.

Keywords

Paediatric cardiologyhypertrophic cardiomyopathycardiac MRIT1 mappingmyocardial strain
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 12 , December 2019 , pp. 1459 - 1467
Copyright
© Cambridge University Press 2019 

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Footnotes

†

Current address: Division of Pediatric Cardiology, Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA

References

Maron, BJ, Doerer, JJ, Haas, TS, Tierney, DM, Mueller, FO. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980-2006. Circulation 2009; 119: 1085–1092. doi: 10.1161/CIRCULATIONAHA.108.804617 CrossRefGoogle ScholarPubMed
Patel, AR, Kramer, CM. Role of cardiac magnetic resonance in the diagnosis and prognosis of nonischemic cardiomyopathy. JACC Cardiovasc Imaging 2017; 10 (10 Pt A): 1180–1193. doi: 10.1016/j.jcmg.2017.08.005 CrossRefGoogle ScholarPubMed
Kellman, P, Wilson, JR, Xue, H, Ugander, M, Arai, AE. Extracellular volume fraction mapping in the myocardium, part 1: evaluation of an automated method. J Cardiovasc Magn Reson 2012; 14: 63. doi: 10.1186/1532-429X-14-63 CrossRefGoogle ScholarPubMed
Miller, CA, Naish, JH, Bishop, P, et al. Comprehensive validation of cardiovascular magnetic resonance techniques for the assessment of myocardial extracellular volume. Circ Cardiovasc Imaging 2013; 6: 373–383. doi: 10.1161/CIRCIMAGING.112.000192 CrossRefGoogle ScholarPubMed
Flett, AS, Hayward, MP, Ashworth, MT, et al. Equilibrium contrast cardiovascular magnetic resonance for the measurement of diffuse myocardial fibrosis: preliminary validation in humans. Circulation 2010; 122: 138–144. doi: 10.1161/CIRCULATIONAHA.109.930636 CrossRefGoogle ScholarPubMed
Iles, LM, Ellims, AH, Llewellyn, H, et al. Histological validation of cardiac magnetic resonance analysis of regional and diffuse interstitial myocardial fibrosis. Eur Heart J Cardiovasc Imaging 2015; 16: 14–22. doi: 10.1093/ehjci/jeu182 CrossRefGoogle ScholarPubMed
Child, N, Suna, G, Dabir, D, et al. Comparison of MOLLI, shMOLLLI, and SASHA in discrimination between health and disease and relationship with histologically derived collagen volume fraction. Eur Heart J Cardiovasc Imaging 2018; 19(7): 768–776. doi: 10.1093/ehjci/jex309 CrossRefGoogle ScholarPubMed
Bogarapu, S, Puchalski, MD, Everitt, MD, Williams, RV, Weng, HY, Menon, SC. Novel Cardiac Magnetic Resonance Feature Tracking (CMR-FT) analysis for detection of myocardial fibrosis in pediatric hypertrophic cardiomyopathy. Pediatr Cardiol 2016; 37: 663–673. doi: 10.1007/s00246-015-1329-8 CrossRefGoogle ScholarPubMed
Wu, LM, An, DL, Yao, QY, et al. Hypertrophic cardiomyopathy and left ventricular hypertrophy in hypertensive heart disease with mildly reduced or preserved ejection fraction: insight from altered mechanics and native T1 mapping. Clin Radiol 2017; 72: 835–843. doi: 10.1016/j.crad.2017.04.019 CrossRefGoogle ScholarPubMed
Haggerty, CM, Suever, JD, Pulenthiran, A, et al. Association between left ventricular mechanics and diffuse myocardial fibrosis in patients with repaired Tetralogy of Fallot: a cross-sectional study. J Cardiovasc Magn Reson 2017; 19: 100. doi: 10.1186/s12968-017-0410-2 CrossRefGoogle ScholarPubMed
Siegel, B, Olivieri, L, Gordish-Dressman, H, Spurney, CF. Myocardial strain using cardiac MR feature tracking and speckle tracking echocardiography in duchenne muscular dystrophy patients. Pediatr Cardiol 2018; 39(3): 478–483. doi: 10.1007/s00246-017-1777-4. [Epub 2017 Nov 29].CrossRefGoogle Scholar
Schulz-Menger, J, Bluemke, DA, Bremerich, J, et al. Standardized image interpretation and post processing in cardiovascular magnetic resonance: society for Cardiovascular Magnetic Resonance (SCMR) board of trustees task force on standardized post processing. J Cardiovasc Magn Reson 2013; 15: 35. doi: 10.1186/1532-429X-15-35 CrossRefGoogle ScholarPubMed
Messroghli, DR, Radjenovic, A, Kozerke, S, Higgins, DM, Sivananthan, MU, Ridgway, JP. Modified Look-Locker inversion recovery (MOLLI) for high-resolution T1 mapping of the heart. Magn Reson Med 2004; 52: 141–146. doi: 10.1002/mrm.20110 CrossRefGoogle Scholar
Kellman, P, Hansen, MS. T1-mapping in the heart: accuracy and precision. J Cardiovasc Magn Reson 2014; 16: 2. doi: 10.1186/1532-429X-16-2 CrossRefGoogle ScholarPubMed
Xue, H, Shah, S, Greiser, A, et al. Motion correction for myocardial T1 mapping using image registration with synthetic image estimation. Magn Reson Med 2012; 67: 1644–1655. doi: 10.1002/mrm.23153 CrossRefGoogle ScholarPubMed
Soslow, JH, Damon, BM, Saville, BR, et al. Evaluation of post-contrast myocardial t1 in duchenne muscular dystrophy using cardiac magnetic resonance imaging. Pediatr Cardiol 2015; 36: 49–56. doi: 10.1007/s00246-014-0963-x CrossRefGoogle ScholarPubMed
Simpson, SA, Field, SL, Xu, M, Saville, BR, Parra, DA, Soslow, JH. Effect of weight extremes on ventricular volumes and myocardial strain in repaired tetralogy of fallot as measured by CMR. Pediatr Cardiol. 2017. doi: 10.1007/s00246-017-1793-4 Google ScholarPubMed
Cerqueira, MD, Weissman, NJ, Dilsizian, V, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the cardiac imaging committee of the council on clinical cardiology of the american heart association. Circulation 2002; 105: 539–542.Google ScholarPubMed
Moon, JC, Messroghli, DR, Kellman, P, et al. Myocardial T1 mapping and extracellular volume quantification: a Society for Cardiovascular Magnetic Resonance (SCMR) and CMR working group of the european society of cardiology consensus statement. J Cardiovasc Magn Reson 2013; 15: 92. doi: 10.1186/1532-429X-15-92 CrossRefGoogle Scholar
Raucci, FJ Jr., Parra, DA, Christensen, JT, et al. Synthetic hematocrit derived from the longitudinal relaxation of blood can lead to clinically significant errors in measurement of extracellular volume fraction in pediatric and young adult patients. J Cardiovasc Magn Reson 2017; 19: 58. doi: 10.1186/s12968-017-0377-z CrossRefGoogle ScholarPubMed
Harris, PA, Taylor, R, Thielke, R, Payne, J, Gonzalez, N, Conde, JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42: 377–381. doi: 10.1016/j.jbi.2008.08.010 CrossRefGoogle ScholarPubMed
Swoboda, PP, McDiarmid, AK, Erhayiem, B, et al. Effect of cellular and extracellular pathology assessed by T1 mapping on regional contractile function in hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 2017; 19: 16. doi: 10.1186/s12968-017-0334-x CrossRefGoogle ScholarPubMed
van den Boomen, M, Slart, R, Hulleman, EV, et al. Native T1 reference values for nonischemic cardiomyopathies and populations with increased cardiovascular risk: a systematic review and meta-analysis. J Magn Reson Imaging 2018; 47: 891–912. doi: 10.1002/jmri.25885 CrossRefGoogle ScholarPubMed
Hinojar, R, Varma, N, Child, N, et al. T1 mapping in discrimination of hypertrophic phenotypes: hypertensive heart disease and hypertrophic cardiomyopathy: findings from the international T1 multicenter cardiovascular magnetic resonance study. Circ Cardiovasc Imaging 2015; 8(12): pii: e003285. doi: 10.1161/CIRCIMAGING.115.003285 CrossRefGoogle ScholarPubMed
Puntmann, VO, Voigt, T, Chen, Z, et al. Native T1 mapping in differentiation of normal myocardium from diffuse disease in hypertrophic and dilated cardiomyopathy. JACC Cardiovasc Imaging 2013; 6: 475–484. doi: 10.1016/j.jcmg.2012.08.019 CrossRefGoogle ScholarPubMed
Parekh, K, Markl, M, Deng, J, de Freitas, RA, Rigsby, CK. T1 mapping in children and young adults with hypertrophic cardiomyopathy. Int J Cardiovasc Imaging 2017; 33: 109–117. doi: 10.1007/s10554-016-0979-9 CrossRefGoogle Scholar
Messroghli, DR, Moon, JC, Ferreira, VM, et al. Clinical recommendations for cardiovascular magnetic resonance mapping of T1, T2, T2* and extracellular volume: a consensus statement by the Society for Cardiovascular Magnetic Resonance (SCMR) endorsed by the European Association for Cardiovascular Imaging (EACVI). J Cardiovasc Magn Reson 2017; 19: 75. doi: 10.1186/s12968-017-0389-8 CrossRefGoogle Scholar
Rosmini, S, Bulluck, H, Captur, G, et al. Myocardial native T1 and extracellular volume with healthy ageing and gender. Eur Heart J Cardiovasc Imaging 2018; 19: 615–621. doi: 10.1093/ehjci/jey034 CrossRefGoogle ScholarPubMed
De Cobelli, F, Esposito, A, Perseghin, G, et al. Intraindividual comparison of gadobutrol and gadopentetate dimeglumine for detection of myocardial late enhancement in cardiac MRI. AJR Am J Roentgenol 2012; 198: 809–816. doi: 10.2214/AJR.11.7118 CrossRefGoogle ScholarPubMed
Rudolph, A, Messroghli, D, von Knobelsdorff-Brenkenhoff, F, et al. Prospective, randomized comparison of gadopentetate and gadobutrol to assess chronic myocardial infarction applying cardiovascular magnetic resonance. BMC Med Imaging 2015; 15: 55. doi: 10.1186/s12880-015-0099-3 CrossRefGoogle ScholarPubMed
Liu, D, Ma, X, Liu, J, et al. Quantitative analysis of late gadolinium enhancement in hypertrophic cardiomyopathy: comparison of diagnostic performance in myocardial fibrosis between gadobutrol and gadopentetate dimeglumine. Int J Cardiovasc Imaging 2017; 33: 1191–1200. doi: 10.1007/s10554-017-1101-7 CrossRefGoogle ScholarPubMed
Kawel, N, Nacif, M, Zavodni, A, et al. T1 mapping of the myocardium: intra-individual assessment of post-contrast T1 time evolution and extracellular volume fraction at 3T for Gd-DTPA and Gd-BOPTA. J Cardiovasc Magn Reson 2012; 14: 26. doi: 10.1186/1532-429X-14-26 CrossRefGoogle ScholarPubMed
Rahsepar, AA, Ghasemiesfe, A, Suwa, K, et al. Comprehensive evaluation of macroscopic and microscopic myocardial fibrosis by cardiac MR: intra-individual comparison of gadobutrol versus gadoterate meglumine. Eur Radiol. 2019. doi: 10.1007/s00330-018-5956-3 CrossRefGoogle ScholarPubMed
Kawel, N, Nacif, M, Zavodni, A, et al. T1 mapping of the myocardium: intra-individual assessment of the effect of field strength, cardiac cycle and variation by myocardial region. J Cardiovasc Magn Reson 2012; 14: 27. doi: 10.1186/1532-429X-14-27 CrossRefGoogle ScholarPubMed