Share：
Share this content in WeChat
X
[Chinese][PDF]241
• Clinical Article •
Exploring the correlation between left atrial strain and left ventricular fibrosis in dilated cardiomyopathy based on cardiac magnetic resonance imaging
YAO Yuheng  LIU Lulu  WU Chen  JIANG Huimin  LI Nan  ZHAI Jian 

Cite this article as: YAO Y H, LIU L L, WU C, et al. Exploring the correlation between left atrial strain and left ventricular fibrosis in dilated cardiomyopathy based on cardiac magnetic resonance imaging[J]. Chin J Magn Reson Imaging, 2025, 16(6): 85-92. DOI:10.12015/issn.1674-8034.2025.06.013.


[Abstract] Objective To explore the correlation between left atrial strain and left ventricular fibrosis in patients with dilated cardiomyopathy (DCM) based on cardiac magnetic resonance (CMR).Materials and Methods We prospectively included 58 patients diagnosed with DCM at the First Affiliated Hospital of Wannan Medical College (Yiji Mountain Hospital of Wannan Medical College) from June 2023 to December 2024, and categorized them into two groups based on the presence of fibrosis. A control group of 40 healthy subjects was selected during the same period. All participants underwent cardiac magnetic resonance imaging, including both standard imaging and late gadolinium enhancement (LGE). General clinical data were collected, and conventional left ventricular and left atrial functional parameters as well as left atrial myocardial strain parameters were obtained using post-processing software. Spearman correlation analysis was conducted to assess the correlation between left atrial functional parameters and myocardial strain parameters, and a correlation heatmap was generated. Univariate and multivariate logistic regression analyses were performed to analyze the association between left atrial myocardial strain and LGE, and receiver operating characteristic (ROC) curves were used to evaluate the diagnostic efficacy of left atrial myocardial strain parameters for left ventricular LGE fibrosis.Results In the DCM group, the left ventricular end-diastolic volume (LVEDV), left ventricular ejection systolic volume (LVESV), heart rate (HR), left ventricular end-diastolic measurement (LVEDM), left atrial minimum volume (LAVmin), and left atrial maximum volume (LAVmax) were all higher than those in the control group, with statistically significant differences (all P < 0.001). The stroke volume (SV), left ventricle ejection fraction (LVEF), cardiac output (CO), cardiac index (CI), left atrial total ejection fraction (LATEF), left atrial passive ejection fraction (LAPEF), and left atrial active ejection fraction (LAAEF) were significantly lower than in the control group, also showing statistically significant differences (all P<0.001). The left atrial reservoir strain (LARS), left atrial conduit strain (LACS), left atrial pump strain (LABS), late diastolic strain rate (SRa), early diastolic strain rate (SRe), and systolic strain rate (SRs) in the DCM group, LGE (+) group, and LGE (-) group were all lower than those in the control group, with statistically significant differences (all P < 0.05). The values of LABS, SRs, SRe, and SRa in the LGE (+) group were lower compared to the LGE (-) group, with statistically significant differences (all P < 0.05). SRe and SRa were positively correlated with LAVmin and LAVmax (P < 0.05), and negatively correlated with LAPEF, LAAEF, and LATEF (P < 0.05). LARS, LACS, LABS, and SRs were negatively correlated with LAVmin and LAVmax (P < 0.05), and positively correlated with LAPEF, LAAEF, and LATEF (P < 0.05). Univariate logistic analysis indicated that the P-values for LABS, SRe, and SRa were all less than 0.05. After adjusting for other potential confounding factors, multivariate logistic analysis showed that SRa was an independent predictor of left ventricular fibrosis in DCM patients (P < 0.05). ROC curve analysis revealed that SRa suggests a curve area under the ROC of 0.854 for predicting left ventricular LGE.Conclusions CMR technology can accurately assess left atrial myocardial strain in patients with DCM, SRa is an independent predictor of left ventricular fibrosis in DCM patients, providing significant value for predicting left ventricular fibrosis.
[Keywords] cardiac magnetic resonance；dilated cardiomyopathy；left atrial strain；fibrosis；magnetic resonance imaging

YAO Yuheng1   LIU Lulu1   WU Chen1   JIANG Huimin2   LI Nan2   ZHAI Jian1*  

1 Department of Radiology, the First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu 241001, China

2 Department of Ultrasound Medicine, the First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu 241001, China

Corresponding author: ZHAI J, E-mail: yjszhaij@126.com

Conflicts of interest   None.

Received  2025-03-18
Accepted  2025-06-05
DOI: 10.12015/issn.1674-8034.2025.06.013
Cite this article as: YAO Y H, LIU L L, WU C, et al. Exploring the correlation between left atrial strain and left ventricular fibrosis in dilated cardiomyopathy based on cardiac magnetic resonance imaging[J]. Chin J Magn Reson Imaging, 2025, 16(6): 85-92. DOI:10.12015/issn.1674-8034.2025.06.013.

[1]
HEYMANS S, LAKDAWALA N K, TSCHÖPE C, et al. Dilated cardiomyopathy: causes, mechanisms, and current and future treatment approaches[J]. Lancet, 2023, 402(10406): 998-1011. DOI: 10.1016/S0140-6736(23)01241-2.
[2]
YASHIMA S, TAKAOKA H, OTA J, et al. Extracellular volume by computed tomography is useful for prediction of prognosis in dilated cardiomyopathy cases with heart failure with reduced ejection fraction[J/OL]. J Cardiovasc Dev Dis, 2024, 11(12): 399 [2025-03-17]. https://pubmed.ncbi.nlm.nih.gov/39728289/. DOI: 10.3390/jcdd11120399.
[3]
WANG X, PU J. Recent advances in cardiac magnetic resonance for imaging of acute myocardial infarction[J/OL]. Small Methods, 2024, 8(3): e2301170 [2025-03-17]. https://pubmed.ncbi.nlm.nih.gov/37992241/. DOI: 10.1002/smtd.202301170.
[4]
Chinese Society of Cardiology, Chinese Medical Association, Chinese College of Cardiovascular Physician, et al. Chinese guidelines for the diagnosis and treatment of heart failure 2024[J]. Chin J Cardiol, 2024, 52(3): 235-275. DOI: 10.3760/cma.j.cn112148-20231101-00405.
[5]
ZHANG H, LI M. Mechanisms and imaging diagnostic advances in dilated cardiomyopathy[J]. Chin J Cardiol, 2023, 45(3): 78-82. DOI: 10.3760/cma.j.cn112148-20230201-00065.
[6]
WANG L, ZHAO Q. Molecular mechanisms of myocardial fibrosis and research progress in cardiovascular diseases[J]. Biomed Eng (Beijing), 2022, 39(S1): 65-70. DOI: 10.3969/j.issn.1672-173X.2022.S1.012.
[7]
ZHANG X P, WANG C, HUANG Y T, et al. Unveiling the diagnostic value of strain parameters across all 4 cardiac chambers in patients with acute myocarditis with varied ejection fraction: a cardiovascular magnetic resonance feature-tracking approach[J/OL]. J Am Heart Assoc, 2024, 13(13): e032781 [2025-03-17]. https://pubmed.ncbi.nlm.nih.gov/38934873/. DOI: 10.1161/JAHA.123.032781.
[8]
PEZESHKI P S, GHORASHI S M, HOUSHMAND G, et al. Feature tracking cardiac magnetic resonance imaging to assess cardiac manifestations of systemic diseases[J]. Heart Fail Rev, 2023, 28(5): 1189-1199. DOI: 10.1007/s10741-023-10321-6.
[9]
GRÖSCHEL J, GRASSOW L, VAN DIJCK P, et al. Trajectories of functional and structural myocardial parameters in post-COVID-19 syndrome-insights from mid-term follow-up by cardiovascular magnetic resonance[J/OL]. Front Cardiovasc Med, 2024, 11: 1357349 [2025-03-17]. https://pubmed.ncbi.nlm.nih.gov/38628318/. DOI: 10.3389/fcvm.2024.1357349.
[10]
COJAN-MINZAT B O, ZLIBUT A, MURESAN I D, et al. Left atrial geometry and phasic function determined by cardiac magnetic resonance are independent predictors for outcome in non-ischaemic dilated cardiomyopathy[J/OL]. Biomedicines, 2021, 9(11): 1653 [2025-03-17]. https://pubmed.ncbi.nlm.nih.gov/34829882/. DOI: 10.3390/biomedicines9111653.
[11]
FENG X Y, ZHENG Y C, YANG Y X, et al. Utilization of cardiac magnetic resonance imaging for assessing myocardial fibrosis in prognosis evaluation and risk stratification of patients with dilated cardiomyopathy[J/OL]. Rev Cardiovasc Med, 2025, 26(1): 25654 [2025-03-17]. https://pubmed.ncbi.nlm.nih.gov/39867184/. DOI: 10.31083/RCM25654.
[12]
ZENG F X, CHEN H Y, LIN W J, et al. Preliminary study on the assessment of left atrial myocardial deformation in patients with hypertrophic cardiomyopathy using CMR technology[J]. Chin J Magn Reson Imag, 2024, 15(9): 74-79. DOI: 10.12015/issn.1674-8034.2024.09.013.
[13]
FERKH A, CLARK A, THOMAS L. Left atrial phasic function: physiology, clinical assessment and prognostic value[J]. Heart, 2023, 109(22): 1661-1669. DOI: 10.1136/heartjnl-2022-321609.
[14]
SHI Y J, LU L, YIN C W, et al. Cardiac MR-feature tracking technique for quantitative analysis of left atrial myocardial strain in dilated cardiomyopathy[J]. Chin J Med Imag Technol, 2021, 37(11): 1661-1665. DOI: 10.13929/j.issn.1003-3289.2021.11.017.
[15]
CSECS I, PASHAKHANLOO F, PASKAVITZ A, et al. Association between left ventricular mechanical deformation and myocardial fibrosis in nonischemic cardiomyopathy[J/OL]. J Am Heart Assoc, 2020, 9(19): e016797 [2025-03-17]. https://pubmed.ncbi.nlm.nih.gov/33006296/. DOI: 10.1161/JAHA.120.016797.
[16]
MĂLĂESCU G G, MIREA O, CAPOTĂ R, et al. Left atrial strain determinants during the cardiac phases[J]. JACC Cardiovasc Imaging, 2022, 15(3): 381-391. DOI: 10.1016/j.jcmg.2021.09.009.
[17]
ZHOU D, WANG Y N, LI S, et al. Ventricular-atrial coupling in subjects with normal, preserved, and reduced left ventricular ejection fraction: insights from cardiac magnetic resonance imaging[J]. Eur Radiol, 2023, 33(11): 7716-7728. DOI: 10.1007/s00330-023-09801-y.
[18]
SONG X Y, GUO J, DONG W. Progress in the clinical application of left atrial strain assessment using cardiac magnetic resonance feature tracking technology[J]. Adv Cardiovasc Dis, 2024, 45(12): 1070-1074. DOI: 10.16806/j.cnki.issn.1004-3934.2024.12.004.
[19]
LIN J R, WU W C, WANG H. Application progress of echocardiographic myocardial strain in heart failure with preserved ejection fraction[J]. Chin J Ultrason, 2021(12): 1096-1099. DOI: 10.3760/cma.j.cn131148-20210609-00399.
[20]
PAPADOPOULOS K, IKONOMIDIS I, CHRISSOHERIS M, et al. MitraClip and left ventricular reverse remodelling: a strain imaging study[J]. ESC Heart Fail, 2020, 7(4): 1409-1418. DOI: 10.1002/ehf2.12750.
[21]
LI Y J, XU Y W, TANG S Q, et al. Left atrial function predicts outcome in dilated cardiomyopathy: fast long-axis strain analysis derived from MRI[J]. Radiology, 2022, 302(1): 72-81. DOI: 10.1148/radiol.2021210801.
[22]
RAAFS A G, VOS J L, HENKENS M T H M, et al. Left atrial strain has superior prognostic value to ventricular function and delayed-enhancement in dilated cardiomyopathy[J]. JACC Cardiovasc Imaging, 2022, 15(6): 1015-1026. DOI: 10.1016/j.jcmg.2022.01.016.
[23]
XIANG X R, SONG Y Y, ZHAO K K, et al. Incremental prognostic value of left atrial and biventricular feature tracking in dilated cardiomyopathy: a long-term study[J/OL]. J Cardiovasc Magn Reson, 2023, 25(1): 76 [2025-03-17]. https://pubmed.ncbi.nlm.nih.gov/38057892/. DOI: 10.1186/s12968-023-00967-4.
[24]
ERLEY J, GENOVESE D, TAPASKAR N, et al. Echocardiography and cardiovascular magnetic resonance based evaluation of myocardial strain and relationship with late gadolinium enhancement[J/OL]. J Cardiovasc Magn Reson, 2019, 21(1): 46 [2025-03-17]. https://pubmed.ncbi.nlm.nih.gov/31391036/. DOI: 10.1186/s12968-019-0559-y.
[25]
RANK N, STOIBER L, NASSER M, et al. Assessment of 10-year left-ventricular-remodeling by CMR in patients following aortic valve replacement[J/OL]. Front Cardiovasc Med, 2021, 8: 645693 [2025-03-17]. https://pubmed.ncbi.nlm.nih.gov/33829049/. DOI: 10.3389/fcvm.2021.645693.
[26]
GRUND F F, KRISTENSEN C B, MYHR K A, et al. Layer-specific strain is preload dependent: comparison between speckle-tracking echocardiography and cardiac magnetic resonance feature-tracking[J]. J Am Soc Echocardiogr, 2021, 34(4): 377-387. DOI: 10.1016/j.echo.2020.12.024.
[27]
YANG X Y, WU J. Application progress of cardiac magnetic resonance in analysis of myocardial strain in hypertrophic cardiomyopathy[J]. Chin J Magn Reson Imag, 2021, 12(2): 105-108. DOI: 10.12015/issn.1674-8034.2021.02.026.
[28]
LI Z M, HAN D, QI T F, et al. Evaluation of myocardial fibrosis in hypertrophic cardiomyopathy via cardiac magnetic resonance T1 mapping[J]. Chin J Med Imag, 2022, 30(4): 341-347. DOI: 10.3969/j.issn.1005-5185.2022.04.008.
[29]
FENG X Y, HE W F, ZHANG T Y, et al. Association between late gadolinium enhancement and outcome in dilated cardiomyopathy: a meta-analysis[J]. World J Radiol, 2023, 15(11): 324-337. DOI: 10.4329/wjr.v15.i11.324.
[30]
CUI Y, CAO Y K, SONG J, et al. Association between myocardial extracellular volume and strain analysis through cardiovascular magnetic resonance with histological myocardial fibrosis in patients awaiting heart transplantation[J/OL]. J Cardiovasc Magn Reson, 2018, 20(1): 25 [2025-03-17]. https://pubmed.ncbi.nlm.nih.gov/29681243/. DOI: 10.1186/s12968-018-0445-z.

PREV The radioscore based on pre-radiotherapy MRI for predicting poor outcome risk in long-term follow-up of glioblastoma patients
NEXT Predictive value of quantitative parameters from DCE-MRI histogram combined with ADC value for chemoradiotherapy efficacy in locally advanced cervical cancer
  


LINK


Tel & Fax: +8610-67113815    E-mail: editor@cjmri.cn