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• Special Focus •
Value of in vivo cardiac diffusion tensor imaging in characterizing the myocardial microstructure of hypertrophic cardiomyopathy
LIU Yujie  DONG Zhixiang  YIN Gang  CHEN Xingrui  XU Wenqing  YANG Shujuan  CHEN Xiuyu  ZHAO Shihua 

DOI:10.12015/issn.1674-8034.2025.11.003.


[Abstract] Objective To verify the feasibility of in vivo cardiac diffusion tensor imaging (cDTI) and further explore its potential clinical value in identifying myocardial microstructural remodeling in hypertrophic cardiomyopathy (HCM).Materials and Methods The prospective study enrolled 37 patients with HCM and 19 healthy controls. The clinical data, cine imaging, late gadolinium enhancement imaging, T1 mapping imaging and cDTI imaging parameters of the two groups were analyzed. The differences in parameters between the two groups were compared using independent sample t-test, chi-square test and non-parametric test. Correlation analysis was conducted between cDTI parameters and native T1, as well as left ventricular wall thickness (LVWT). Covariance analysis was used to evaluate the cDTI parameters after adjusting for native T1 and LVWT.Results LVWT, left ventricular mass index and native T1 of HCM patients were higher than healthy controls and differences were statistically significant. cDTI parameters like mean diffusivity (MD) (P < 0.001) and fractional anisotropy (FA) (P < 0.001) were lower than healthy controls. Secondary eigenvector angle (E2A) was higher than controls (P < 0.001). These differences were statistically significant. Both FA and E2A have high diagnostic efficacy in differentiating HCM patients from healthy controls, with the area under the curve (AUC) being 0.98 (95% confidence intervals: 0.94 to 1.00) and 0.88 (95% confidence intervals: 0.80 to 0.97), respectively. Correlation analysis shows LVWT was moderately negatively correlated with FA (r = -0.754, P < 0.001), and moderately positively correlated with E2A (r = 0.636, P < 0.001). Native T1 was moderately negatively correlated with FA (r = -0.504, P < 0.001), and weakly positively correlated with E2A (r = 0.330, P = 0.013). Analysis of covariance shows that, after adjusting for LVWT and native T1, FA of HCM patients was still significantly decreased.Conclusions As a non-invasive quantitative assessment method for myocardial tissue characteristics that does not rely on contrast agents, in vivo cDTI has the ability to identify myocardial disarray in HCM patients.
[Keywords] hypertrophic cardiomyopathy；magnetic resonance imaging；diffusion tensor imaging；cardiovascular magnetic resonance；disarray；microstructure

LIU Yujie1   DONG Zhixiang1   YIN Gang1   CHEN Xingrui1   XU Wenqing1   YANG Shujuan2   CHEN Xiuyu1   ZHAO Shihua1*  

1 Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China

2 Department of Medical Imaging, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China

Corresponding author: ZHAO S H, E-mail: cjrzhaoshihua2009@163.com

Conflicts of interest   None.

Received  2025-08-07
Accepted  2025-10-29
DOI: 10.12015/issn.1674-8034.2025.11.003
DOI:10.12015/issn.1674-8034.2025.11.003.

[1]
OMMEN S R, HO C Y, ASIF I M, et al. 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR guideline for the management of hypertrophic cardiomyopathy: a report of the American heart association/American college of cardiology joint committee on clinical practice guidelines[J/OL]. Circulation, 2024, 149(23): e1239-e1311 [2025-08-06]. https://pubmed.ncbi.nlm.nih.gov/38718139/. DOI: 10.1161/CIR.0000000000001250.
[2]
CUI C, ZHAO S H, YAN F H, et al. MRI findings of hypertrophic cardiomyopathy[J]. Chin J Radiol, 2024, 58(3): 350-357. DOI: 10.3760/cma.j.cn112149-20231227-00495.
[3]
FINOCCHIARO G, RADAELLI D, D'ERRICO S, et al. Sudden cardiac death among adolescents in the United Kingdom[J]. J Am Coll Cardiol, 2023, 81(11): 1007-1017. DOI: 10.1016/j.jacc.2023.01.041.
[4]
FINOCCHIARO G, WESTABY J, SHEPPARD M N, et al. Sudden cardiac death in young athletes: JACC state-of-the-art review[J]. J Am Coll Cardiol, 2024, 83(2): 350-370. DOI: 10.1016/j.jacc.2023.10.032.
[5]
VARNAVA A M, ELLIOTT P M, BABOONIAN C, et al. Hypertrophic cardiomyopathy[J]. Circulation, 2001, 104(12): 1380-1384. DOI: 10.1161/hc3701.095952.
[6]
ASHKIR Z, SAMAT A A, ARIGA R, et al. Myocardial disarray and fibrosis across hypertrophic cardiomyopathy stages associate with ECG markers of arrhythmic risk[J]. Eur Heart J Cardiovasc Imaging, 2025, 26(2): 218-228. DOI: 10.1093/ehjci/jeae260.
[7]
FINOCCHIARO G, SHEIKH N, LEONE O, et al. Arrhythmogenic potential of myocardial disarray in hypertrophic cardiomyopathy: genetic basis, functional consequences and relation to sudden cardiac death[J]. Europace, 2021, 23(7): 985-995. DOI: 10.1093/europace/euaa348.
[8]
SAUMAREZ R C. Electrophysiological investigation of patients with hypertrophic cardiomyopathy. Evidence that slowed intraventricular conduction is associated with an increased risk of sudden death[J/OL]. Br Heart J, 1994, 72(6Suppl): S19-S23 [2025-08-06]. https://pubmed.ncbi.nlm.nih.gov/7873318/. DOI: 10.1136/hrt.72.6_suppl.s19.
[9]
Cardiomyopathy Specialty Alliance, National Center for Cardiovascular Diseases; Cardiovascular Precision Medicine Branch, China International Exchange and Promotive Association for Medical and Health Care; Expert Group on the Clinical Application of Endomyocardial Biopsy and Pathological Examination in Cardiomyopathy. Guidelines for the Clinical Application of Endomyocardial Biopsy and Pathological Examination in Cardiomyopathy[J]. Chin Circ J, 2024, 39(12): 1145-1155. DOI: 10.3969/j.issn.1000-3614.2024.12.001.
[10]
KHALIQUE Z, FERREIRA P F, SCOTT A D, et al. Diffusion tensor cardiovascular magnetic resonance imaging: a clinical perspective[J]. JACC Cardiovasc Imaging, 2020, 13(5): 1235-1255. DOI: 10.1016/j.jcmg.2019.07.016.
[11]
TANG Y, MA X, DONG Z X, et al. Cardiac magnetic resonance visualization of the myocardial microstructure in non-ischemic cardiomyopathies[J/OL]. Cardiovasc Innov Appl, 2024, 9(1) [2025-08-07]. https://www.scienceopen.com/hosted-document?doi=10.15212/CVIA.2024.0042. DOI: 10.15212/cvia.2024.0042.
[12]
ARIGA R, TUNNICLIFFE E M, MANOHAR S G, et al. Identification of myocardial disarray in patients with hypertrophic cardiomyopathy and ventricular arrhythmias[J]. J Am Coll Cardiol, 2019, 73(20): 2493-2502. DOI: 10.1016/j.jacc.2019.02.065.
[13]
NIELLES-VALLESPIN S, KHALIQUE Z, FERREIRA P F, et al. Assessment of myocardial microstructural dynamics by in vivo diffusion tensor cardiac magnetic resonance[J]. J Am Coll Cardiol, 2017, 69(6): 661-676. DOI: 10.1016/j.jacc.2016.11.051.
[14]
TSENG W I, WEDEEN V J, REESE T G, et al. Diffusion tensor MRI of myocardial fibers and sheets: correspondence with visible cut-face texture[J]. J Magn Reson Imaging, 2003, 17(1): 31-42. DOI: 10.1002/jmri.10223.
[15]
VON DEUSTER C, SAMMUT E, ASNER L, et al. Studying dynamic myofiber aggregate reorientation in dilated cardiomyopathy using in vivo magnetic resonance diffusion tensor imaging[J/OL]. Circ Cardiovasc Imaging, 2016, 9(10): e005018 [2025-08-07]. https://pubmed.ncbi.nlm.nih.gov/27729361/. DOI: 10.1161/CIRCIMAGING.116.005018.
[16]
YANG W J, ZHAO S H, LU M J. Progress of cardiovascular magnetic resonance diffusion tensor imaging and diffusion spectrum magnetic resonance imaging[J]. Chin J Magn Reson Imag, 2021, 12(10): 93-97. DOI: 10.12015/issn.1674-8034.2021.10.024.
[17]
RAHMAN T, MOULIN K, PEROTTI L E. Cardiac diffusion tensor biomarkers of chronic infarction based on in vivo data[J/OL]. Appl Sci (Basel), 2022, 12(7): 3512 [2025-08-07]. https://pubmed.ncbi.nlm.nih.gov/36032414/. DOI: 10.3390/app12073512.
[18]
DAS A, KELLY C, TEH I, et al. Phenotyping hypertrophic cardiomyopathy using cardiac diffusion magnetic resonance imaging: the relationship between microvascular dysfunction and microstructural changes[J]. Eur Heart J Cardiovasc Imaging, 2022, 23(3): 352-362. DOI: 10.1093/ehjci/jeab210.
[19]
The Joint Committee of Cardiomyopathy Specialty Alliance, National Center for Cardiovascular Diseases/Cardiovascular Precision Medicine Branch of China International Exchange and Promotive Association for Medical and Health Care. 2023 guideline for diagnosis and treatment of patients with hypertrophic cardiomyopathy[J]. Chin Circ J, 2023, 38(1): 1-33. DOI: 10.3969/j.issn.1000-3614.2023.01.001.
[20]
ARBELO E, PROTONOTARIOS A, GIMENO J R, et al. 2023 ESC guidelines for the management of cardiomyopathies: developed by the task force on the management of cardiomyopathies of the European society of cardiology (ESC)free[J]. Eur Heart J, 2023, 44(37): 3503-3626. DOI: 10.1093/eurheartj/ehad194.
[21]
NAUFFAL V, KLARQVIST M D R, HILL M C, et al. Noninvasive assessment of organ-specific and shared pathways in multi-organ fibrosis using T1 mapping[J]. Nat Med, 2024, 30(6): 1749-1760. DOI: 10.1038/s41591-024-03010-w.
[22]
MOULIN K, VERZHBINSKY I A, MAFORO N G, et al. Probing cardiomyocyte mobility with multi-phase cardiac diffusion tensor MRI[J/OL]. PLoS One, 2020, 15(11): e0241996 [2025-08-06]. https://pubmed.ncbi.nlm.nih.gov/33180823/. DOI: 10.1371/journal.pone.0241996.
[23]
DALL'ARMELLINA E, ENNIS D B, AXEL L, et al. Cardiac diffusion-weighted and tensor imaging: a consensus statement from the special interest group of the society for cardiovascular magnetic resonance[J/OL]. J Cardiovasc Magn Reson, 2025, 27(1): 101109 [2025-08-06]. https://pubmed.ncbi.nlm.nih.gov/39442672/. DOI: 10.1016/j.jocmr.2024.101109.
[24]
DONG Z X, TANG Y, SUN P, et al. Early identification of myocardial microstructural alterations in hypertrophic cardiomyopathy with in vivo cardiac diffusion-tensor imaging[J/OL]. Radiol Cardiothorac Imaging, 2025, 7(1): e240009 [2025-08-06]. https://pubmed.ncbi.nlm.nih.gov/39745326/. DOI: 10.1148/ryct.240009.
[25]
CAPTUR G, MANISTY C H, RAMAN B, et al. Maximal wall thickness measurement in hypertrophic cardiomyopathy: biomarker variability and its impact on clinical care[J]. JACC Cardiovasc Imaging, 2021, 14(11): 2123-2134. DOI: 10.1016/j.jcmg.2021.03.032.
[26]
NIE W X, GAO L, LI Y, et al. Application of quantitative parameters of CMR T1-maping in hypertrophic cardiomyopathy: native T1 and ECV[J]. Chin J CT MRI, 2023, 21(5): 49-51. DOI: 10.3969/j.issn.1672-5131.2023.05.017.
[27]
PARWANI P, CHEN T, ALLEN B, et al. Challenges and opportunities for early career medical professionals in cardiovascular magnetic resonance (CMR) imaging: a white paper from the Society for Cardiovascular Magnetic Resonance[J/OL]. J Cardiovasc Magn Reson, 2023, 25(1): 65 [2025-08-06]. https://pubmed.ncbi.nlm.nih.gov/37968709/. DOI: 10.1186/s12968-023-00968-3.
[28]
JOY G, KELLY C I, WEBBER M, et al. Microstructural and microvascular phenotype of sarcomere mutation carriers and overt hypertrophic cardiomyopathy[J]. Circulation, 2023, 148(10): 808-818. DOI: 10.1161/CIRCULATIONAHA.123.063835.
[29]
LAPENNA E, NISI T, CARINO D, et al. Hypertrophic cardiomyopathy with moderate septal thickness and mitral regurgitation: long-term surgical results[J]. Eur J Cardio Thorac Surg, 2021, 60(2): 244-251. DOI: 10.1093/ejcts/ezab097.
[30]
NIELLES-VALLESPIN S, SCOTT A, FERREIRA P, et al. Cardiac diffusion: technique and practical applications[J]. J Magn Reson Imaging, 2020, 52(2): 348-368. DOI: 10.1002/jmri.26912.
[31]
DAS A, CHOWDHARY A, KELLY C, et al. Insight into myocardial microstructure of athletes and hypertrophic cardiomyopathy patients using diffusion tensor imaging[J]. J Magn Reson Imaging, 2021, 53(1): 73-82. DOI: 10.1002/jmri.27257.
[32]
TAKAYAMA Y, COSTA K D, COVELL J W. Contribution of laminar myofiber architecture to load-dependent changes in mechanics of LV myocardium[J/OL]. Am J Physiol Heart Circ Physiol, 2002, 282(4): H1510-H1520 [2026-08-06]. https://pubmed.ncbi.nlm.nih.gov/11893589/. DOI: 10.1152/ajpheart.00261.2001.
[33]
FACTOR S M, BUTANY J, SOLE M J, et al. Pathologic fibrosis and matrix connective tissue in the subaortic myocardium of patients with hypertrophic cardiomyopathy[J]. J Am Coll Cardiol, 1991, 17(6): 1343-1351. DOI: 10.1016/s0735-1097(10)80145-7.
[34]
LAIRD J, PERERA G, BATORSKY R, et al. Spatial transcriptomic analysis of focal and normal areas of myocyte disarray in human hypertrophic cardiomyopathy[J/OL]. Int J Mol Sci, 2023, 24(16): 12625 [2026-08-06]. https://pubmed.ncbi.nlm.nih.gov/37628806/. DOI: 10.3390/ijms241612625.
[35]
BAKERMANS A J, KOUWENHOVEN M, DE VOS J, et al. A comparison of myocardial magnetic resonance extracellular volume mapping at 3 T against histology of tissue collagen in severe aortic valve stenosis and obstructive hypertrophic cardiomyopathy[J]. MAGMA, 2023, 36(5): 701-709. DOI: 10.1007/s10334-023-01070-6.
[36]
FERREIRA P F, KILNER P J, MCGILL L A, et al. In vivo cardiovascular magnetic resonance diffusion tensor imaging shows evidence of abnormal myocardial laminar orientations and mobility in hypertrophic cardiomyopathy[J/OL]. J Cardiovasc Magn Reson, 2014, 16(1): 87 [2026-08-06]. https://pubmed.ncbi.nlm.nih.gov/25388867/. DOI: 10.1186/s12968-014-0087-8.
[37]
WU L M, CHEN B H, YAO Q Y, et al. Quantitative diffusion-weighted magnetic resonance imaging in the assessment of myocardial fibrosis in hypertrophic cardiomyopathy compared with T1 mapping[J]. Int J Cardiovasc Imaging, 2016, 32(8): 1289-1297. DOI: 10.1007/s10554-016-0909-x.
[38]
HUANG J H, FERREIRA P F, WANG L C, et al. Deep learning-based diffusion tensor cardiac magnetic resonance reconstruction: a comparison study[J/OL]. Sci Rep, 2024, 14: 5658 [2026-08-06]. https://www.nature.com/articles/s41598-024-55880-2. DOI: 10.1038/s41598-024-55880-2.
[39]
HUO Z M, WEN K, LUO Y Q, et al. Referenceless Nyquist ghost correction outperforms standard Navigator-based method and improves efficiency of in vivo diffusion tensor cardiovascular magnetic resonance[J]. Magn Reson Med, 2024, 91(6): 2403-2416. DOI: 10.1002/mrm.30012.

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