Zlibut Alexandru, Muresan Ioana Danuta, Bietenbeck Michael, Radu Andrei Dan, Agoston-Coldea Lucia
Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania.
Division of Cardiovascular Imaging, Department of Cardiology I, University Hospital Muenster, 48149 Muenster, Germany.
Biomedicines. 2025 Aug 15;13(8):1986. doi: 10.3390/biomedicines13081986.
: Hypertrophic cardiomyopathy (HCM) is frequently associated with preserved left ventricular ejection fraction (LVEF), yet subclinical myocardial dysfunction often escapes detection using conventional imaging. Cardiac magnetic resonance (CMR) with feature tracking (FT) enables precise assessment of myocardial deformation and mechanics. : In this prospective case-control study, we evaluated 150 HCM patients and 100 age- and sex-matched healthy controls using standardized CMR protocols. Global longitudinal strain (GLS), circumferential strain (GCS), radial strain (GRS), and left ventricular (LV) torsion were quantified via FT-CMR. Myocardial fibrosis was assessed through late gadolinium enhancement (LGE), native T1 mapping, and extracellular volume (ECV). : HCM patients showed significantly impaired strain and torsion metrics compared with controls: GLS (-16% vs. -20%), GCS (-18% vs. -21%), GRS (29% vs. 38%), and global LV torsion (1.27°/cm vs. 1.95°/cm), all < 0.001. These abnormalities were also observed in LGE-negative patients, suggesting early functional remodeling. Global LV torsion demonstrated the highest diagnostic performance for LGE detection (AUC = 0.995), surpassing those of GLS (0.877), native T1 (0.731), and ECV (0.657). A cut-off value of 0.7°/cm provided optimal sensitivity and specificity, and was associated with adverse prognosis in survival analysis. : CMR-derived strain and torsion parameters detect early myocardial dysfunction in HCM beyond conventional markers. Global LV torsion, in particular, emerges as a sensitive and robust non-invasive marker with diagnostic and prognostic potential.
肥厚型心肌病（HCM）常伴有左心室射血分数（LVEF）保留，但亚临床心肌功能障碍常难以通过传统成像检测到。具有特征追踪（FT）功能的心脏磁共振成像（CMR）能够精确评估心肌变形和力学情况。
在这项前瞻性病例对照研究中，我们使用标准化的CMR方案评估了150例HCM患者和100例年龄及性别匹配的健康对照者。通过FT-CMR对整体纵向应变（GLS）、圆周应变（GCS）、径向应变（GRS）和左心室（LV）扭转进行了量化。通过延迟钆增强（LGE）、原生T1映射和细胞外容积（ECV）评估心肌纤维化。
与对照组相比，HCM患者的应变和扭转指标明显受损：GLS（-16%对-20%）、GCS（-18%对-21%）、GRS（29%对38%）和整体LV扭转（1.27°/cm对1.95°/cm），所有P均<0.001。在LGE阴性患者中也观察到了这些异常，提示早期功能重塑。整体LV扭转对LGE检测的诊断性能最高（AUC = 0.995），超过了GLS（0.877）、原生T1（0.731）和ECV（0.657）。0.7°/cm的截断值提供了最佳的敏感性和特异性，并且在生存分析中与不良预后相关。
CMR衍生的应变和扭转参数可检测出HCM中超出传统标志物的早期心肌功能障碍。特别是整体LV扭转，成为一种敏感且可靠的非侵入性标志物，具有诊断和预后潜力。
