Abstract
Objectives
To investigate the correlation between the extent of excessive trabeculation assessed by fractal dimension (FD) and myocardial contractility assessed by cardiac MRI feature tracking in patients with left ventricular noncompaction (LVNC) and normal left ventricular ejection fraction (LVEF).
Methods
Forty-one LVNC patients with normal LVEF (≥ 50%) and 41 healthy controls were retrospectively included. All patients fulfilled three available diagnostic criteria on MRI. Cardiac MRI feature tracking was performed on cine images to determine left ventricular (LV) peak strains in three directions: global radial strain (GRS), global circumferential strain (GCS), and global longitudinal strain (GLS). The complexity of excessive trabeculation was quantified by fractal analysis on short-axis cine stacks.
Results
Compared with controls, patients with LVNC had impaired GRS, GCS, and GLS (all p < 0.05). The global, maximal, and regional FD values of the LVNC population were all significantly higher than those of the controls (all p < 0.05). Global FD was positively correlated with the end-diastolic volume index, end-systolic volume index, and stroke volume index (r = 0.483, 0.505, and 0.335, respectively, all p < 0.05), but negatively correlated with GRS and GCS (r = − 0.458 and 0.508, respectively, both p < 0.001). Moreover, apical FD was also weakly associated with LVEF and GLS (r = − 0.249 and 0.252, respectively, both p < 0.05).
Conclusion
In patients with LVNC, LV systolic dysfunction was detected early by cardiac MRI feature tracking despite the presence of normal LVEF and was associated with excessive trabecular complexity assessed by FD.
Key Points
• Left ventricular global strain was already impaired in patients with extremely prominent excessive trabeculation but normal left ventricular ejection fraction.
• An increased fractal dimension was associated with impaired deformation in left ventricular noncompaction.
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Abbreviations
- AUC:
-
Area under the curve
- CI:
-
Cardiac index
- EDVi:
-
End-diastolic volume index
- ESVi:
-
End-systolic volume index
- FD:
-
Fractal dimension
- GCS:
-
Global circumferential strain
- GLS:
-
Global longitudinal strain
- GRS:
-
Global radial strain
- IQR:
-
Interquartile range
- LV:
-
Left ventricular
- LVEF:
-
Left ventricular ejection fraction
- LVNC:
-
Left ventricular noncompaction
- SVi:
-
Stroke volume index
References
Kayvanpour E, Sedaghat-Hamedani F, Gi WT et al (2019) Clinical and genetic insights into non-compaction: a meta-analysis and systematic review on 7598 individuals. Clin Res Cardiol 108(11):1297–1308
Anderson RH, Jensen B, Mohun TJ et al (2017) Key questions relating to left ventricular noncompaction cardiomyopathy: is the emperor still wearing any clothes? Can J Cardiol 33(6):747–757
Oechslin E, Jenni R (2018) Left ventricular noncompaction: from physiologic remodeling to noncompaction cardiomyopathy. J Am Coll Cardiol 71(7):723–726
Oechslin E, Jenni R, Klaassen S (2021) Left ventricular noncompaction is a myocardial phenotype: cardiomyopathy-yes or no? Can J Cardiol 37(3):366–369
Gati S, Rajani R, Carr-White GS, Chambers JB (2014) Adult left ventricular noncompaction: reappraisal of current diagnostic imaging modalities. JACC Cardiovasc Imaging 7(12):1266–1275
D’Silva A, Jensen B (2021) Left ventricular non-compaction cardiomyopathy: how many needles in the haystack? Heart 107(16):1344–1352
Weir-McCall JR, Yeap PM, Papagiorcopulo C et al (2016) Left ventricular noncompaction: anatomical phenotype or distinct cardiomyopathy? J Am Coll Cardiol 68(20):2157–2165
Captur G, Muthurangu V, Cook C et al (2013) Quantification of left ventricular trabeculae using fractal analysis. J Cardiovasc Magn Reson 15:36
Captur G, Lopes LR, Patel V et al (2014) Abnormal cardiac formation in hypertrophic cardiomyopathy: fractal analysis of trabeculae and preclinical gene expression. Circ Cardiovasc Genet 7(3):241–248
Cai J, Bryant JA, Le TT et al (2017) Fractal analysis of left ventricular trabeculations is associated with impaired myocardial deformation in healthy Chinese. J Cardiovasc Magn Reson 19(1):102
Dawes TJW, Cai J, Quinlan M et al (2018) Fractal analysis of right ventricular trabeculae in pulmonary hypertension. Radiology 288(2):386–395
Zheng T, Ma X, Li S et al (2019) Value of cardiac magnetic resonance fractal analysis combined with myocardial strain in discriminating isolated left ventricular noncompaction and dilated cardiomyopathy. J Magn Reson Imaging 50(1):153–163
Wang J, Li Y, Yang F et al (2021) Fractal analysis: prognostic value of left ventricular trabecular complexity cardiovascular MRI in participants with hypertrophic cardiomyopathy. Radiology 298(1):71–79
van Dalen BM, Caliskan K, Soliman OI et al (2008) Left ventricular solid body rotation in non-compaction cardiomyopathy: a potential new objective and quantitative functional diagnostic criterion? Eur J Heart Fail 10(11):1088–1093
Bellavia D, Michelena HI, Martinez M et al (2010) Speckle myocardial imaging modalities for early detection of myocardial impairment in isolated left ventricular non-compaction. Heart 96(6):440–447
van Dalen BM, Caliskan K, Soliman OI et al (2011) Diagnostic value of rigid body rotation in noncompaction cardiomyopathy. J Am Soc Echocardiogr 24(5):548–555
Chen X, Li L, Cheng H et al (2019) Early left ventricular involvement detected by cardiovascular magnetic resonance feature tracking in arrhythmogenic right ventricular cardiomyopathy: the effects of left ventricular late gadolinium enhancement and right ventricular dysfunction. J Am Heart Assoc 8(17):e012989
Kraigher-Krainer E, Shah AM, Gupta DK et al (2014) Impaired systolic function by strain imaging in heart failure with preserved ejection fraction. J Am Coll Cardiol 63(5):447–456
Petersen SE, Selvanayagam JB, Wiesmann F et al (2005) Left ventricular non-compaction: insights from cardiovascular magnetic resonance imaging. J Am Coll Cardiol 46(1):101–105
Grothoff M, Pachowsky M, Hoffmann J et al (2012) Value of cardiovascular MR in diagnosing left ventricular non-compaction cardiomyopathy and in discriminating between other cardiomyopathies. Eur Radiol 22(12):2699–2709
Jacquier A, Thuny F, Jop B et al (2010) Measurement of trabeculated left ventricular mass using cardiac magnetic resonance imaging in the diagnosis of left ventricular non-compaction. Eur Heart J 31(9):1098–1104
Cerqueira MD, Weissman NJ, Dilsizian V et al (2002) 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 105(4):539–542
Cai J (2017) UK-Digital-Heart-Project/fracAnalyse: fracAnalyse v1.2. https://github.com/UK-Digital-Heart-Project/fracAnalyse
Ross SB, Jones K, Blanch B et al (2020) A systematic review and meta-analysis of the prevalence of left ventricular non-compaction in adults. Eur Heart J 41(14):1428–1436
Zemrak F, Ahlman MA, Captur G et al (2014) The relationship of left ventricular trabeculation to ventricular function and structure over a 9.5-year follow-up: the MESA study. J Am Coll Cardiol 64(19):1971–1980
van Waning JI, Caliskan K, Chelu RG et al (2021) Diagnostic cardiovascular magnetic resonance imaging criteria in noncompaction cardiomyopathy and the yield of genetic testing. Can J Cardiol 37(3):433–442
Dreisbach JG, Mathur S, Houbois CP et al (2020) Cardiovascular magnetic resonance based diagnosis of left ventricular non-compaction cardiomyopathy: impact of cine bSSFP strain analysis. J Cardiovasc Magn Reson 22(1):9
Nucifora G, Sree Raman K, Muser D et al (2017) Cardiac magnetic resonance evaluation of left ventricular functional, morphological, and structural features in children and adolescents vs. young adults with isolated left ventricular non-compaction. Int J Cardiol 246:68–73
Paun B, Bijnens B, Butakoff C (2018) Relationship between the left ventricular size and the amount of trabeculations. Int J Numer Method Biomed Eng 34(3). https://doi.org/10.1002/cnm.2939
Captur G, Zemrak F, Muthurangu V et al (2015) Fractal analysis of myocardial trabeculations in 2547 study participants: Multi-Ethnic Study of Atherosclerosis. Radiology 277(3):707–715
Funding
This study was co-funded by the National Natural Science Foundation of China (No. 81930044, No. 81620108015).
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The scientific guarantor of this publication is Shihua Zhao.
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Yu, S., Chen, X., Yang, K. et al. Correlation between left ventricular fractal dimension and impaired strain assessed by cardiac MRI feature tracking in patients with left ventricular noncompaction and normal left ventricular ejection fraction. Eur Radiol 32, 2594–2603 (2022). https://doi.org/10.1007/s00330-021-08346-2
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DOI: https://doi.org/10.1007/s00330-021-08346-2