Comparison Study Of Isolated Left Ventricular Noncompaction And Dilated Cardiomyopathy Using Cardiac Magnetic Resonance

Objective:To study the clinical manifestations and magnetic resonance features of left ventricular noncompaction and dilated cardiomyopathy using fractal analysis and tissue tracking.To explore the value of MRI in differential diagnosis between the two diseases.Material and method:A consecutive series of 35 patients with LVNC(23 males,44.5±17.1 years)and30 patients with DCM(21 males,47.4±16.4 years)were included.Twenty healthy volunteers(13 males,40.0±6.4 years)were selected as control group.All groups were matched for age,gender and body surface area.All participants were performed CMR examination on a 1.5 T MRI scanner.Imaging protocols including FIESTA cine sequence,first pass perfusion and late gadolinium enhancement(LGE).According to17-segment model(AHA)left ventricle segmentation,the ratio of noncompaction(NC)to compaction myocardium(C)in 16 segments of left ventricular(LV)myocardium(except apical cap)at end-diastole was calculated,and the distribution of noncompaction myocardium(NC/C>1)in LVNC group and DCM group was described.Image analysis was performed using CVI 42.0.The degree of LV trabeculation was assessed by fractal analysis,including:mean global FD,max apical FD.Myocardial strain was assessed by tissue tracking,including:GPSR,GPSC,GPSL,PRSR_D,PCSR_D,PLSR_D,PRSRs,PCSRS,PLSRS.Left ventricular function was assessed by Cardiac VX,including:EDV,ESV,LVEF,SV,CO.Means of two variables were compared by independent samples Student’s t-test or Mann-Whitney U test.The cut-off value of mean global FD and max apical FD for diagnosing LVNC was assessed with receiver operating characteristics(ROC)curves.Results:The distribution of noncompaction myocardium in LVNC group and DCM group:apical segments(Segment 13th,14th,15th,16th)were involved in all LVNC patients,while apical segments of DCM patients were not affected,and other segments in the two groups were basically similar.The GPLS showed significant differences between LVNC group and DCM group[–6.49(–11.41,–4.90)vs.–4.61(–5.87,–3.61),P=0.006].Max apical FD and mean global FD were higher in LVNC group than in DCM group(1.433±0.074 vs.1.341±0.062,P<0.001;1.323±0.036vs.1.267±0.041,P<0.001;respectively).For diagnosing LVNC,the cut-off value of max apical FD was 1.392(AUC=0.881,95%CI:0.804~0.957),and the cut-off value of mean global FD was 1.283(AUC=0.895,95%CI:0.828~0.961).Both LVNC and DCM groups had reduced strain and strain rate values compared with the controls(P<0.001).Conclusions:The combination of fractal analysis with myocardial strain provides a novel biomarker in distinguishing LVNC from DCM.Fractal analysis provides a quantitative measurement of myocardial trabeculation.