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Title: Left ventricular wall stress is sensitive marker of hypertrophic cardiomyopathy with preserved ejection fraction
Authors: Zhao, X
Tan, R.-S 
Tang, H.-C 
Teo, S.-K
Su, Y
Wan, M
Leng, S
Zhang, J.-M 
Allen, J 
Kassab, G.S
Zhong, L 
Keywords: adult
area under the curve
cardiovascular magnetic resonance
cardiovascular parameters
clinical article
controlled study
end diastolic phase
end diastolic wall stress index
end systolic phase
heart ejection fraction
heart left ventricle wall
heart left ventricular shape
heart stress
heart ventricle wall
hypertrophic cardiomyopathy
image analysis
image reconstruction
mathematical analysis
regional wall curvature
sensitivity and specificity
wall stress index
Issue Date: 2018
Citation: Zhao, X, Tan, R.-S, Tang, H.-C, Teo, S.-K, Su, Y, Wan, M, Leng, S, Zhang, J.-M, Allen, J, Kassab, G.S, Zhong, L (2018). Left ventricular wall stress is sensitive marker of hypertrophic cardiomyopathy with preserved ejection fraction. Frontiers in Physiology 9 (MAR) : 250. ScholarBank@NUS Repository.
Rights: Attribution 4.0 International
Abstract: Hypertrophic cardiomyopathy (HCM) patients present altered myocardial mechanics due to the hypertrophied ventricular wall and are typically diagnosed by the increase in myocardium wall thickness. This study aimed to quantify regional left ventricular (LV) shape, wall stress and deformation from cardiac magnetic resonance (MR) images in HCM patients and controls, in order to establish superior measures to differentiate HCM from controls. A total of 19 HCM patients and 19 controls underwent cardiac MR scans. The acquired MR images were used to reconstruct 3D LV geometrical models and compute the regional parameters (i.e., wall thickness, curvedness, wall stress, area strain and ejection fraction) based on the standard 16 segment model using our in-house software. HCM patients were further classified into four quartiles based on wall thickness at end diastole (ED) to assess the impact of wall thickness on these regional parameters. There was a significant difference between the HCM patients and controls for all regional parameters (P < 0.001). Wall thickness was greater in HCM patients at the end-diastolic and end-systolic phases, and thickness was most pronounced in segments at the septal regions. A multivariate stepwise selection algorithm identified wall stress index at ED (?i,ED) as the single best independent predictor of HCM (AUC = 0.947). At the cutoff value ?i,ED < 1.64, both sensitivity and specificity were 94.7%. This suggests that the end-diastolic wall stress index incorporating regional wall curvature-an index based on mechanical principle-is a sensitive biomarker for HCM diagnosis with potential utility in diagnostic and therapeutic assessment. © 2018 Zhao, Tan, Tang, Teo, Su, Wan, Leng, Zhang, Allen, Kassab and Zhong.
Source Title: Frontiers in Physiology
ISSN: 1664042X
DOI: 10.3389/fphys.2018.00250
Rights: Attribution 4.0 International
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