Pierpaolo Palumbo1,2, Francesco Masedu3, Camilla De Cataldo4, Ester Cannizzaro5, Federico Bruno6,3, Silvia Pradella6,7, Francesco Arrigoni5, Marco Valenti3, Alessandra Splendiani3, Antonio Barile3, Andrea Giovagnoni8, Carlo Masciocchi3, Ernesto Di Cesare9. 1. Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, Via Saragat, Località Campo di Pile, 67100, L'Aquila, Italy. palumbopierpaolo89@gmail.com. 2. SIRM Foundation, Italian Society of Medical and Interventional Radiology (SIRM), 20122, Milan, Italy. palumbopierpaolo89@gmail.com. 3. Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, Italy. 4. Radiology Unit, San Salvatore Hospital of L'Aquila, Via Lorenzo Natali 1, 67100, L'Aquila, Italy. 5. Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, Via Saragat, Località Campo di Pile, 67100, L'Aquila, Italy. 6. SIRM Foundation, Italian Society of Medical and Interventional Radiology (SIRM), 20122, Milan, Italy. 7. Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy. 8. Department of Radiology, Azienda Ospedaliero-Universitaria, Ospedale Riuniti Di Ancona, Via Conca 71, 60126, Torrette, Ancona, Italy. 9. Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100, L'Aquila, Italy.
Abstract
OBJECTIVE: Cardiac magnetic resonance (CMR) is an uncontested diagnostic tool for identifying and assessing hypertrophic cardiomyopathy (HCM) patients. Concerning the necessity to identify valid prognosticators for predicting the individual risk of clinical evolution, this study aimed to evaluate the clinical validity of CMR tissue tracking (TT) analysis in patients affected by primitive HCM in a real-world setting. METHODS: This historical prospective study included 33 patients. Diagnostic validity and clinical validation were assessed for strain values. CMR-TT diagnostic validity was studied comparing HCM patients with healthy control groups and phenotypic presentation of HCM. The impact of strain values and all phenotypic disease characteristics were assessed in a long-term follow-up study. RESULTS: The inter-reading agreement was good for all strain parameters. Significant differences were observed between the control group and HCM patients. Similarly, hypertrophic and LGE + segments showed lower deformability than healthy segments. The AUC of predictive model, including conventional risk factors for MACE occurrence and all strain values, reached 98% of diagnostic concordance (95% CI .94-1; standard error: .02; p value .0001), compared to conventional risk factors only (86%; 95% CI .73-99; standard error: .07; p value .002). CONCLUSION: In patients with primitive HCM, CMR-TT strain proves high clinical validity providing independent and non-negligible prognostic advantages over clinical features and traditional CMR markers.
OBJECTIVE: Cardiac magnetic resonance (CMR) is an uncontested diagnostic tool for identifying and assessing hypertrophic cardiomyopathy (HCM) patients. Concerning the necessity to identify valid prognosticators for predicting the individual risk of clinical evolution, this study aimed to evaluate the clinical validity of CMR tissue tracking (TT) analysis in patients affected by primitive HCM in a real-world setting. METHODS: This historical prospective study included 33 patients. Diagnostic validity and clinical validation were assessed for strain values. CMR-TT diagnostic validity was studied comparing HCM patients with healthy control groups and phenotypic presentation of HCM. The impact of strain values and all phenotypic disease characteristics were assessed in a long-term follow-up study. RESULTS: The inter-reading agreement was good for all strain parameters. Significant differences were observed between the control group and HCM patients. Similarly, hypertrophic and LGE + segments showed lower deformability than healthy segments. The AUC of predictive model, including conventional risk factors for MACE occurrence and all strain values, reached 98% of diagnostic concordance (95% CI .94-1; standard error: .02; p value .0001), compared to conventional risk factors only (86%; 95% CI .73-99; standard error: .07; p value .002). CONCLUSION: In patients with primitive HCM, CMR-TT strain proves high clinical validity providing independent and non-negligible prognostic advantages over clinical features and traditional CMR markers.
Authors: Perry M Elliott; Aris Anastasakis; Michael A Borger; Martin Borggrefe; Franco Cecchi; Philippe Charron; Albert Alain Hagege; Antoine Lafont; Giuseppe Limongelli; Heiko Mahrholdt; William J McKenna; Jens Mogensen; Petros Nihoyannopoulos; Stefano Nistri; Petronella G Pieper; Burkert Pieske; Claudio Rapezzi; Frans H Rutten; Christoph Tillmanns; Hugh Watkins Journal: Eur Heart J Date: 2014-08-29 Impact factor: 29.983