CMR feature tracking strain patterns and their association with circulating cardiac biomarkers in patients with hypertrophic cardiomyopathy

AIMS: CMR feature tracking strain (CMR-FT) provides prognostic information. However, there is a paucity of data in hypertrophic cardiomyopathy (HCM). We sought to analyze global CMR-FT parameters in all four cardiac chambers and to assess associations with NT-proBNP and cardiac troponin T (hsTnT) in patients with HCM. METHODS: This retrospective study included 144 HCM patients and 16 healthy controls with CMR at 1.5 T. Analyses were performed on standard steady-state free precession cine (SSFP) CMR data using a commercially available software. Global left ventricular (LV) strain was assessed as longitudinal (LV(LAX-)GLS), circumferential (LV(LAX-)GCS) and radial strain (LV(LAX-)GRS) on long -axis (LAX) and as LV(SAX)-GCS and LV(SAX)-GRS on short- axis (SAX). Right ventricular (RV-GLS), left atrial (LA-GLS) and right atrial (RA-GLS) strain were assessed on LAX. RESULTS: We found LV(LAX)-GLS [− 18.9 (− 22.0, − 16.0), − 23.5 (− 25.5, − 22.0) %, p = 0.0001), LV(SAX)-GRS [86.8 (65.9–115.5), 119.6 (91.3–143.7) %, p = 0.001] and LA(LAX)-GLS [LA(2CH)-GLS 29.2 (19.1–37.7), LA(2CH)-GLS 38.2 (34.3–47.1) %, p = 0.0036; LA(4CH)-GLS 22.4 (14.6–30.7) vs. LA(4CH)-GLS 33.4 (28.4–37.3) %, p = 0.0033] to be impaired in HCM compared to healthy controls despite normal LVEF. Furthermore, LV and LA strain parameters were impaired in HCM with elevated NT-proBNP and/or hsTnT, despite preserved LVEF compared to HCM with normal biomarker levels. There was a moderate correlation of LV and LA CMR-FT with levels of NT-proBNP and hsTnT. CONCLUSION: CMR-FT reveals LV and LA dysfunction in HCM despite normal LVEF. The association between impaired LV strain and elevated NT-proBNP and hsTnT indicates a link between unapparent functional abnormalities and disease severity in HCM. GRAPHIC ABSTRACT: Typical CMR-FT findings in patients with hypertrophic cardiomyopathy [Image: see text]