Myocardial Strain Characteristics in Non-Obstructive Hypertrophic Cardiomyopathy and Left Ventricular Hypertrophy: Insights from Cardiac MRI Feature Tracking

Presenting Author(s)

• 

  Zainab Magomedova, MD

  Radiologist
  City Clinical Hospital №1 named after N.I. Pirogov
  Moscow, Moskva, Russia

Co-Author(s)

• KK

  Konstantin Kovalev

  Radiologist
  City Clinical Hospital №1 named after N.I. Pirogov, Russia

Primary Author(s)

• 

  Zainab Magomedova, MD

  Radiologist
  City Clinical Hospital №1 named after N.I. Pirogov
  Moscow, Moskva, Russia

Co-Author(s)

• 

  Ekaterina Pershina, PhD

  Radiologist
  City Clinical Hospital №1 named after N.I. Pirogov
  Moscow, Moskva, Russia
• DS

  Dmitry Shchekochikhin, PhD

  Cardiologist
  Sechenov First Moscow State Medical University (Sechenov University), Russia
• DA

  Denis Andreev, MD

  Cardiologist
  Sechenov First Moscow State Medical University (Sechenov University), Russia

Background: Left ventricular hypertrophy (LVH) is a common imaging finding with a broad spectrum of underlying causes, ranging from physiological adaptation to pathological conditions such as hypertension and hypertrophic cardiomyopathy (HCM). Accurate differentiation between non-obstructive HCM and hypertensive LVH is critical for risk assessment and guiding clinical management. Cardiac magnetic resonance imaging (CMR) with Feature Tracking (FT) enables noninvasive assessment of myocardial deformation (strain), offering valuable insights for differential diagnosis.

Aim:
To investigate myocardial strain parameters in patients with non-obstructive HCM and hypertensive LVH, and to evaluate the diagnostic potential of CMR-based strain analysis.

Methods: This prospective, single-center study included 96 patients with LV wall thickness ≥14 mm and indexed LV mass ≥50 g/m², along with 35 healthy control subjects. Patients with obstructive HCM or known storage diseases were excluded. All subjects underwent CMR using a 1.5T Toshiba scanner with standard cine imaging sequences. FT analysis was used to quantify global radial (GRS), circumferential (GCS), and longitudinal (GLS) strain in both 2D and 3D formats. Statistical assessments involved t-tests, ANOVA, and ROC curve analysis, with p-values < 0.05 considered statistically significant.

Results: Participants were categorized into three groups: HCM (n=29), hypertensive LVH (n=32), and healthy controls (n=35). There were no significant age or gender differences among groups.

Global longitudinal strain (GLS) showed the most marked differences:

• 2D GLS: HCM −10.24 ± 5.19%, LVH −13.23 ± 2.7%, controls −16.02 ± 2.02% (p < 0.01)


• 3D GLS: HCM −8.66 ± 3.16%, LVH −10.19 ± 4.35%, controls −13.74 ± 2.97% (p < 0.01)

Receiver Operating Characteristic (ROC) analysis indicated:

• 2D GLS cutoff: −11.08% (sensitivity 90%, specificity 51%)


• 3D GLS cutoff: −8.19% (sensitivity 84%, specificity 51%)

No statistically significant differences were observed in GRS or GCS across groups.

Conclusion: Feature Tracking-based strain analysis with cardiac MRI demonstrates diagnostic value in distinguishing non-obstructive HCM from hypertensive LVH. Global longitudinal strain (GLS), particularly 2D-based, emerged as the most informative parameter. Incorporating FT-derived strain, especially GLS, into standard CMR protocols may enhance diagnostic clarity in patients with increased myocardial thickness. Despite current limitations, FT offers a promising and accessible approach to refining cardiomyopathy evaluation.

ROC curves for strains.