Quantitative assessment of myocardial dysfunction in mild focal left ventricular hypertrophy using CMR feature tracking.

Abstract

Objectives: This study aimed to investigate cardiac dysfunction in patients with mild focal left ventricular hypertrophy (MF-LVH) by analyzing the left ventricular (LV) and left atrial (LA) deformation parameters derived from cardiac magnetic resonance feature tracking (CMR-FT).

Methods: This retrospective study included 36 patients with MF-LVH, 44 patients with HCM without late gadolinium enhancement (HCM-non-LGE), and 32 healthy controls who were examined between November 2020 and August 2025. The LA and LV strain parameters were obtained using CMR-FT. Statistical comparisons, multivariable logistic regression, and receiver operating characteristic (ROC) curve analyses were conducted.

Results: While conventional parameters showed no difference, all global LV strains and most strain rate parameters were significantly impaired in both patient groups, showing a stepwise decline with advancing hypertrophy severity. In multivariable analyses, the peak diastolic radial strain rate (PD-RSR) was the primary discriminator distinguishing MF-LVH from controls, and LV global longitudinal strain (LV-GLS) was the key discriminator differentiating MF-LVH from HCM-non-LGE. LV-GLS and LA minimal volume index (LAVImin) were the key discriminators for HCM-non-LGE versus controls. ROC analysis confirmed LV-GLS as an excellent discriminator (AUC 0.85 for MF-LVH vs. HCM-non-LGE; AUC 0.96 for HCM-non-LGE vs. controls), with notably similar optimal cutoff values (-13.94% and -13.99%, respectively). PD-RSR showed good accuracy in identifying MF-LVH.

Conclusion: PD-RSR indicates early diastolic impairment, and LV-GLS sensitively detects systolic dysfunction in patients with MF-LVH. The overlapping LV-GLS values between patients with MF-LVH and HCM-non-LGE suggest a potential pathophysiological continuum. CMR-FT enables early detection of subclinical myocardial dysfunction in this population.