Hypertrabeculated Left Ventricular Myocardium in Relationship to                    Myocardial Function and Fibrosis: The Multi-Ethnic Study of                    Atherosclerosis

Kawel‐Boehm, Nadine; McClelland, Robyn L.; Zemrak, Filip; Captur, Gabriella; Hundley, W. Gregory; Liu, Chia Ying; Moon, James; Petersen, Steffen E.; Ambale-Venkatesh, Bharath; Lima, João A.C.; Bluemke, David A.

doi:10.1148/radiol.2017161995

Cited by 25 publications

(15 citation statements)

References 29 publications

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“…Unlike NC/C ratio, FD as a measure of LV trabeculation was associated with increased cardiac volumes and LV mass (more eccentric hypertrophy phenotype), but not LV concentricity. Although reduction in myocardial deformation has been shown in LVNC patients [ 36 – 39 ], our study demonstrated progressive impairment in regional circumferential strain with LV trabeculation extent even in healthy individuals. This was consistent with recent findings by Kawel et al [ 39 ], and we further demonstrated an impairment in diastolic relaxation with increased LV trabeculation in healthy subjects.…”

Section: Discussioncontrasting

confidence: 58%

“…Although reduction in myocardial deformation has been shown in LVNC patients [ 36 – 39 ], our study demonstrated progressive impairment in regional circumferential strain with LV trabeculation extent even in healthy individuals. This was consistent with recent findings by Kawel et al [ 39 ], and we further demonstrated an impairment in diastolic relaxation with increased LV trabeculation in healthy subjects. Of note, NC/C ratio lacked any associations with strain parameters, underscoring the limitations of NC/C ratio.…”

Section: Discussioncontrasting

confidence: 58%

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Fractal analysis of left ventricular trabeculations is associated with impaired myocardial deformation in healthy Chinese

Cai

Bryant

et al. 2016

Journal of Cardiovascular Magnetic Resonance

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BackgroundLeft ventricular (LV) non-compaction (LVNC) is defined by extreme LV trabeculation, but is measured variably. Here we examined the relationship between quantitative measurement in LV trabeculation and myocardial deformation in health and disease and determined the clinical utility of semi-automated assessment of LV trabeculations.MethodsCardiovascular magnetic resonance (CMR) was performed in 180 healthy Singaporean Chinese (age 20–69 years; males, n = 91), using balanced steady state free precession cine imaging at 3T. The degree of LV trabeculation was assessed by fractal dimension (FD) as a robust measure of trabeculation complexity using a semi-automated technique. FD measures were determined in healthy men and women to derive normal reference ranges. Myocardial deformation was evaluated using feature tracking. We tested the utility of this algorithm and the normal ranges in 10 individuals with confirmed LVNC (non-compacted/compacted; NC/C ratio > 2.3 and ≥1 risk factor for LVNC) and 13 individuals with suspected disease (NC/C ratio > 2.3).ResultsFractal analysis is a reproducible means of assessing LV trabeculation extent (intra-class correlation coefficient: intra-observer, 0.924, 95% CI [0.761–0.973]; inter-observer, 0.925, 95% CI [0.821–0.970]). The overall extent of LV trabeculation (global FD: 1.205 ± 0.031) was independently associated with increased indexed LV end-diastolic volume and mass (sβ = 0.35; p < 0.001 and sβ = 0.13; p < 0.01, respectively) after adjusting for age, sex and body mass index. Increased LV trabeculation was independently associated with reduced global circumferential strain (sβ = 0.17, p = 0.013) and global diastolic circumferential and radial strain rates (sβ = 0.25, p < 0.001 and sβ = −0.15, p = 0.049, respectively). Abnormally high FD was observed in all patients with a confirmed diagnosis of LVNC. Five out of 13 individuals with suspected LVNC had normal FD, despite NC/C > 2.3.ConclusionThis study defines the normal range of LV trabeculation in healthy Chinese that can be used to make or refute a diagnosis of LVNC using the fractal analysis tool, which we make freely available. We also show that increased myocardial trabeculation is associated with higher LV volumes, mass and reduced myocardial strain.Electronic supplementary materialThe online version of this article (10.1186/s12968-017-0413-z) contains supplementary material, which is available to authorized users.

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Section: Discussioncontrasting

confidence: 58%

Section: Discussioncontrasting

confidence: 58%

Fractal analysis of left ventricular trabeculations is associated with impaired myocardial deformation in healthy Chinese

Cai

Bryant

et al. 2016

Journal of Cardiovascular Magnetic Resonance

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“…Other researchers found similar results in pediatric patients and lower than normal GCS values in adult LVNC patients with good LV function as well [29,31]. However, decreased GCS and GRS values were also present in healthy participants with LV hypertrabeculation, and Cai et al described that higher global fractal dimension values were independently associated with decreased GCS after adjusting for age, sex and body mass index [32,33]. This result raises the question of whether the presence of LV hypertrabeculation causes this alteration or subclinical LV dysfunction is already present in LVNC patients regardless of having good LV function.…”

Section: Discussionmentioning

confidence: 66%

Changes in strain parameters at different deterioration levels of left ventricular function: A cardiac magnetic resonance feature-tracking study of patients with left ventricular noncompaction

Szũcs¹,

Kiss²,

Gregor³

et al. 2021

International Journal of Cardiology

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Background: There is a lack of cardiac MRI information on left ventricular (LV) strain and rotational parameters of left ventricular noncompaction (LVNC) patients with reduced ejection fraction (EF). Thus, we sought to use feature tracking (FT) to describe these changes at different levels of EF deterioration. Methods: We included 31 adult LVNC patients with reduced LV EF (Group B, EF < 50%) without any comorbidities or concomitant cardiac diseases, 31 age-and sex-matched LVNC patients with good EF (Group A, EF > 50%) and 31 healthy controls. Group B was divided according to LV EF into two subgroups (Group B-1: EF 35-50%, Group B-2: EF < 35%). Their global longitudinal, circumferential (GCS), and radial (GRS) strains; LV segmental strains; LV apical and basal rotation values; and patterns and degree of LV dyssynchrony were measured. Results: All of the global and mean segmental strain parameters were significantly worse in Groups B, B-1 and B-2 than in Group A and in the controls. The LV mechanical dispersion increased as LV EF decreased. The degree of apical rotation was the highest in the control group, almost the same in Group A and the lowest and in the reverse direction in Group B-2. A rotational pattern, clockwise-directed rigid body rotation (RBR), was found in 39% of the Group B patients, and a counterclockwise-directed RBR was found in 26% of the Group A patients. Conclusions: The strain values and rotational parameters changed as the EF decreased. These changes affected the global LV, and we did not identify an LVNC-specific strain pattern.

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“…Only 6% of participants in the study had a maximum ratio .2.3 in more than 2 regions in an older age population (mean age of 68 years). 502,521 See Table 5 for diagnostic criteria for LVNC.…”

Section: Section 6 Future Directions and Research Recommendationsmentioning

confidence: 99%

2019 HRS expert consensus statement on evaluation, risk stratification, and management of arrhythmogenic cardiomyopathy

et al. 2019

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This international consensus statement is intended to help cardiologists and other health care professionals involved in the care of adult and pediatric patients with arrhythmogenic cardiomyopathy (ACM), which encompasses a broad range of disorders, by providing recommendations for evaluation and management and supporting shared decision making between health care providers and patients in a document format that is also useful at the point of care.This consensus statement was written by experts in the field chosen by the Heart Rhythm Society (HRS) and collaborating organizations.

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Hypertrabeculated Left Ventricular Myocardium in Relationship to Myocardial Function and Fibrosis: The Multi-Ethnic Study of Atherosclerosis

Cited by 25 publications

References 29 publications

Fractal analysis of left ventricular trabeculations is associated with impaired myocardial deformation in healthy Chinese

Fractal analysis of left ventricular trabeculations is associated with impaired myocardial deformation in healthy Chinese

Changes in strain parameters at different deterioration levels of left ventricular function: A cardiac magnetic resonance feature-tracking study of patients with left ventricular noncompaction

2019 HRS expert consensus statement on evaluation, risk stratification, and management of arrhythmogenic cardiomyopathy

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