Predictive Value Of Entropy And Myocardial Strain Based On CMR For MACE In Patients With Hypertrophic Cardiomyopathy

Objectives:This study investigated the predictive value of left ventricular entropy based on late gadolinium enhancement(CMR-LGE)images and left ventricular myocardial strain quantified by cardiac magnetic resonance feature tracking(CMR-FT)for major cardiac adverse event(MACE)in patients with HCM.Methods : Patients diagnosed with HCM by clinical and cardiac magnetic resonance(CMR)from January 2015 to December 2021 were included in the historical cohort study.All patients met the diagnostic criteria for HCM proposed by ESC in 2014,and follow-up time of all patients ≧ 6 months.According to the follow-up results,the patients were divided into MACE group and non-MACE group.The study is divided into two parts:Part Ⅰ: The cardiac movie sequences were imported into the post-processing software CVI42 to obtain the cardiac structural parameters [including left atrial diameter(LAD),right atrial diameter(RAD),left ventricular end-diastolic diameter(LVEDD),right ventricular end-diastolic diameter(RVEDD),aortic root sinus diameter,and left ventricular maximum wall thickness(LVMWT)].Left ventricular function parameters[including left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular mass(LVM)and left ventricular mass index(LVMI)] were obtained by CVI42 function module.CMR-LGE images were imported into Python 3.8 software to obtain left ventricular entropy.Part Two: Via CVI42 Left ventricular myocardial strain parameters[including radial peak strain(RPS),circumferential peak strain(CPS),longitudinal peak strain(LPS),radial peak systolic strain rate(RPSSR),circumferential peak systolic strain rate(CPSSR),longitudinal peak systolic strain rate(LPSSR)and radial peak diastolic strain,were obtained by strain module Rate(RPDSR),circumferential peak diastolic strain rate(CPDSR),longitudinal peak diastolic strain rate(LPDSR)].Using independent sample t test,the Mann-Whitney U line inspection,Chi-square test between the two groups,further multivariate logistic regression analysis of HCM patients occurred MACE effective risk factors,and establish the logistic single factor and multiple factors combined forecasting model.The receiver operating characteristic(ROC)curve was used to analyze the prediction efficiency of each model and the optimal cut-off value,sensitivity and specificity of each model.The difference of prediction efficiency was compared by Delong test.The predictive value of each CMR parameter to MACE was evaluated by ROC curve,and the optimal cut-off value,sensitivity and specificity of each parameter were obtained.Results: A total of 126 patients with HCM were included,including 39 patients in the MACE group and 87 patients without MACE.The median follow-up was 25 months.Part Ⅰ: Prediction value of left ventricular entropy in patients with HCM based on CMR-LGE(1)Comparison of CMR structure and function parameters between MACE group and non-Mace group LAD[(39.02±7.54)mm vs(34.95±7.55)mm],LVMWT[(21.32±4.48)mm vs(19.12±3.29)mm] and left ventricular entropy [5.16(4.00,6.23)vs 4.27(2.77,5.46)] were higher than those without MACE(P < 0.05);The LVEF of MACE group [56.18(45.01,62.95)vs 61.15(54.87,66.90)] was smaller than that of non-Mace group(P=0.017).(2)Multivariate logistic regression showed that LVEF(OR=0.960,95%CI:0.928-0.993,P=0.017),left ventricular entropy(OR=1.616,95%CI: 1.172-2.227,P=0.003)were independent risk factors for MACE in HCM patients.(3)ROC curve showed that the area under the curve(AUC)of LVEF univariate prediction model was 0.633,the optimal cut-off value was 52.41%,the sensitivity was41.0%,and the specificity was 85.1%.The AUC of left ventricular entropy univariate prediction model was 0.690,the optimal cut-off value was 4.984,the sensitivity was64.1%,and the specificity was 69.0%.The AUC of the prediction model of left ventricular entropy combined with LVEF was 0.714.Part Ⅱ: Prediction value of left ventricular myocardial strain quantified by CMR-FT in patients with HCM(1)Comparison of left ventricular myocardial strain parameters between the MACE group and the no-MACE group showed that CPS[(-14.13±4.27)vs(-16.60±3.85)]and LPS[(-6.79±2.74)vs(-8.76±3.10)] in the MACE group were greater than those in the no-Mace group.RPS[(26.24±10.67)vs(32.32±10.58)],CPDSR[0.68(0.59,0.87)vs 0.86(0.66,1.06)],LPDSR[0.46(0.38,0.68)vs in MACE group 0.62(0.48,0.82)]was lower than that in the group without MACE(P < 0.05).(2)ROC curve showed that the AUC of each parameter in predicting the occurrence of MACE in HCM patients was LPS(AUC=0.683,95%CI: 0.594 ～ 0.763,P < 0.001),CPS(AUC=0.666,95%CI: 0.576 ～ 0.747,P=0.001),LAD(AUC=0.661,95%CI:0.571 ～ 0.743,P=0.003),RPS(AUC=0.655,95%CI: 0.565-0.737,P=0.004),CPDSR(AUC=0.650,95%CI: 0.560-0.733,P=0.004),LPDSR(AUC=0.642,95%CI:0.552-0.725,P=0.010),LVMWT(AUC=0.639,95%CI: 0.548-0.722,P=0.016),LVEF(AUC=0.633,95%CI: 0.542-0.717,P=0.018).The optimal cut-off value of LPS was-7.98,the sensitivity was 71.8%,and the specificity was 57.5%.The optimal cut-off value of CPS was-16.65,the sensitivity was 71.8% and the specificity was58.6%.The optimal cut-off value of LAD was 38.4,the sensitivity was 61.5%,and the specificity was 71.3%.The optimal cut-off value of RPS was 27.78,the sensitivity was 64.1%,and the specificity was 67.8%.The optimal cut-off value of CPDSR was0.85,the sensitivity was 74.4%,and the specificity was 55.2%.The optimal cut-off value of LPDSR was 0.45,the sensitivity was 48.7%,and the specificity was 80.5%.The optimal truncation value of LVMWT was 21.3,the sensitivity was 53.8%,and the specificity was 79.3%.The optimal cut-off value of LVEF was 52.41,the sensitivity was 41.0%,and the specificity was 85.1%.Conclusion:(1)Left ventricular entropy based on CMR-LGE image can reflect myocardial tissue heterogeneity and is an effective predictor of prognosis in HCM patients.The risk of developing MACE in HCM patients increases with the increase of left ventricular entropy.Combined with LVEF can help provide a more comprehensive risk stratification for HCM patients.(2)CMR-FT technique can be used to evaluate the abnormal left ventricular myocardial strain in patients with HCM,and has a certain value in predicting the risk of MACE.LPS was the best predictor of MACE.When LPS≥-7.98,the risk rate of MACE in HCM patients increased.