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CMR-derived rapid long-axis strain in predicting extensive myocardial fibrosis in hypertrophic cardiomyopathy
CHEN Zixian  YANG Na  NAN Jiang  ZHANG Yaping  XU Lei  LEI Junqiang 

DOI:10.12015/issn.1674-8034.2025.11.005.


[Abstract] Objective To investigate the correlation between left ventricular fast long-axis strain (FLAS) measured from cardiac magnetic resonance (CMR) cine sequences and extensive late gadolinium enhancement (LGE) in patients with hypertrophic cardiomyopathy (HCM), and to compare its predictive value for extensive myocardial fibrosis against global longitudinal strain (GLS).Materials and Methods A retrospective analysis was conducted on clinical baseline data and CMR imaging from 131 patients diagnosed with HCM and 75 age- and sex-matched normal controls at the First Hospital of Lanzhou University between January 2017 and January 2021. Patients were divided into extensive LGE and non-extensive LGE groups based on LGE extent. FLAS parameter was measured from the two- and four-chamber left ventricular cine sequences. Pearson correlation analysis was used to explore the relationship between FLAS and LGE extent. Univariate and multivariate logistic regression analyses were employed to assess the association between FLAS and LGE. The diagnostic performance of FLAS for identifying extensive LGE was evaluated using receiver operating characteristic (ROC) curve analysis.Results Patients in the extensive LGE group were younger [(52 ± 11) years vs. (57 ± 13) years, P = 0.025)], had higher diastolic blood pressure [(79 ± 10) mmHg vs. (74 ± 12) mmHg, P = 0.016], and showed a statistically significant lower incidence of hypertension (27.3% vs. 51.7%, P = 0.008) compared to the non-extensive LGE group. FLAS was significantly lower in the extensive LGE group [( -9.24% ± 2.73%) vs. (-12.41% ± 2.84%), P < 0.001)] and a moderate negative correlation was observed between LGE extent and FLAS (r = -0.497, P < 0.001). ROC curve analysis showed that the area under the curve (AUC) for FLAS in identifying extensive LGE was 0.802, which was significantly superior to GLS (AUC = 0.709) and traditional CMR parameters (LVMi, LVESVi, LVEF, and MLVT, with AUCs of 0.626, 0.703, 0.725, and 0.702, respectively). Multivariate regression analysis further confirmed FLAS as an independent predictor of extensive LGE (OR = 1.497, 95% CI: 1.550 to 2.663, P < 0.001).Conclusions As a novel contrast-agent-free CMR functional parameter, FLAS demonstrates superior performance to GLS and traditional parameters in identifying extensive myocardial fibrosis in HCM patients. It holds promise as a non-invasive tool for myocardial fibrosis assessment, serving as an alternative to LGE, especially in patients with contraindications to gadolinium contrast or renal insufficiency.
[Keywords] hypertrophic cardiomyopathy；cardiac magnetic resonance；fast long-axis strain；myocardial fibrosis；late gadolinium enhancement

CHEN Zixian1   YANG Na1   NAN Jiang1   ZHANG Yaping1   XU Lei2   LEI Junqiang1*  

1 Department of Radiology, the First Hospital of Lanzhou University, the First School of Clinical Medicine, Lanzhou 730000, China

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

Corresponding author: LEI J Q, E-mail: leijq2011@126.com

Conflicts of interest   None.

Received  2025-08-07
Accepted  2025-10-27
DOI: 10.12015/issn.1674-8034.2025.11.005
DOI:10.12015/issn.1674-8034.2025.11.005.

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