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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: jonathan.h.soslow@vumc.org
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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

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