Glycemic Influences on Hypertrophic Cardiomyopathy Myocardium: Insights From Cardiac MRI Feature Tracking.

Abstract

Background: Hypertrophic cardiomyopathy (HCM) is a genetic disorder associated with left ventricular hypertrophy and elevated cardiovascular risk. Emerging evidence suggests glycemic disturbances may exacerbate myocardial injury.

Purpose: To evaluate the effects of prediabetes and diabetes on myocardium in patients with HCM using cardiac MRI feature tracking (FT).

Study type: Retrospective.

Population: One hundred thirty five participants (age: 58 ± 10 years; 60% male), divided into four subgroups according to the left ventricular maximal wall thickness (LVMWT) and hemoglobin A1c (HbA1c) level: 36 patients with HCM, 39 patients with prediabetes-HCM, 30 patients with diabetes-HCM, and 30 controls.

Field strength/sequence: 3.0 T/balanced steady-state free precession cine and phase-sensitive inversion-prepared late gadolinium enhancement (LGE) sequences.

Assessment: The left ventricular global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and their corresponding strain rates (GLSr, GCSr, GRSr), endocardial right ventricular GLS, as well as the presence and extent of replacement myocardial fibrosis, were assessed using Medis software and correlated with glycemic status (HbA1c and LVMWT).

Statistical tests: Descriptive statistics, analysis of variance, Pearson/Spearman correlation coefficients (r), and stepwise regression. p < 0.05 indicated statistical significance.

Results: LV-GRS was significantly lower in prediabetes and diabetes-HCM than HCM alone (62.7% ± 7.7% vs. 50.1% ± 5.6% vs. 43.4% ± 6.2%). LV-GLS and endocardial right ventricular GLS were also significantly reduced (LV-GLS: -23.2% ± 2.7% vs. -20.5% ± 3.6% vs. -18.1 ± 3.6; endo RV-GLS: -36.0% ± 6.7% vs. -30.9% ± 7.1% vs. -26.6 ± 7.0). After adjusting for age, sex, hypertension, and LV mass, LV-GRS remained significantly different across groups. Additionally, a significant negative correlation was observed between LV-GRS and HbA1c (r = -0.631), whereas a significant positive correlation was found between LV-GLS and LVMWT (r = 0.220).

Data conclusions: Strain parameters derived from cardiac MRI FT may detect early myocardial damage in patients with HCM with prediabetes or diabetes, emphasizing the importance of early glycemic control.

Evidence level: 3.

Technical efficacy: Stage 2.