Hypertrabeculated left ventricular myocardium in relationship to myocardial function and fibrosis: The multi-ethnic study of atherosclerosis

Nadine Kawel-Boehm, Robyn L. McClelland, Filip Zemrak, Gabriella Captur, W. Gregory Hundley, Chia Ying Liu, James C. Moon, Steffen E. Petersen, Bharath Ambale Venkatesh, Joao Lima, David A. Bluemke

Research output: Contribution to journalArticle

Abstract

Purpose: To determine if excess greater left ventricle (LV) trabeculation is associated with decreased average regional myocardial function, diffuse fibrosis, or both. Materials and Methods: This was a HIPAA-compliant institutional board approved multicenter study, and all participants provided written informed consent. Participants in the Multi-Ethnic Study of Atherosclerosis (MESA) underwent a comprehensive cardiac magnetic resonance (MR) examination. LV trabeculation was measured with the maximal apical fractal dimension (FD), which is a marker of endocardial complexity. Demographic covariates, cardiovascular risk factors, and cardiac MR measurements were compared across quartiles of FD. Associations between FD and peak regional systolic circumferential strain (Ecc) and T1 time, a surrogate for diffuse myocardial fibrosis, were assessed with multivariable linear regression models. Results: A total of 1123 subjects (593 [52.8%] female; mean age, 67.1 years ± 8.7 [standard deviation]) underwent FD and Ecc measurement, and 992 (521 [52.5%] female; mean age, 67.1 years ± 8.7) underwent FD and T1 measurement. Mean FD was 1.2 ± 0.07 in both groups, and mean Ecc was 218.3 ± 2.27 in the subjects who underwent FD and Ecc measurement. Global volumes and ejection fraction showed no differences between FD quartiles. However, with increasing FD quartile, Ecc was greater (indicating worse average regional function) (P <.001). After adjustment, greater trabeculation was associated with 21% worse myocardial strain (relative to the mean) per unit change in FD (regression coefficient = 4.0%; P < .001). There was no association between the degree of trabeculation and diffuse fibrosis measured with T1 mapping. Conclusion: Average regional LV function was worse in individuals with greater LV trabeculation, supporting the concept of hypertrabeculation being an epiphenomenon of disease.

Original languageEnglish (US)
Pages (from-to)667-675
Number of pages9
JournalRadiology
Volume284
Issue number3
DOIs
StatePublished - Sep 1 2017

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Fractals
Atherosclerosis
Myocardium
Fibrosis
Heart Ventricles
Linear Models
Magnetic Resonance Spectroscopy
Health Insurance Portability and Accountability Act
Informed Consent
Multicenter Studies
Demography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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Kawel-Boehm, N., McClelland, R. L., Zemrak, F., Captur, G., Hundley, W. G., Liu, C. Y., ... Bluemke, D. A. (2017). Hypertrabeculated left ventricular myocardium in relationship to myocardial function and fibrosis: The multi-ethnic study of atherosclerosis. Radiology, 284(3), 667-675. https://doi.org/10.1148/radiol.2017161995

Hypertrabeculated left ventricular myocardium in relationship to myocardial function and fibrosis : The multi-ethnic study of atherosclerosis. / Kawel-Boehm, Nadine; McClelland, Robyn L.; Zemrak, Filip; Captur, Gabriella; Hundley, W. Gregory; Liu, Chia Ying; Moon, James C.; Petersen, Steffen E.; Ambale Venkatesh, Bharath; Lima, Joao; Bluemke, David A.

In: Radiology, Vol. 284, No. 3, 01.09.2017, p. 667-675.

Research output: Contribution to journalArticle

Kawel-Boehm, N, McClelland, RL, Zemrak, F, Captur, G, Hundley, WG, Liu, CY, Moon, JC, Petersen, SE, Ambale Venkatesh, B, Lima, J & Bluemke, DA 2017, 'Hypertrabeculated left ventricular myocardium in relationship to myocardial function and fibrosis: The multi-ethnic study of atherosclerosis', Radiology, vol. 284, no. 3, pp. 667-675. https://doi.org/10.1148/radiol.2017161995
Kawel-Boehm, Nadine ; McClelland, Robyn L. ; Zemrak, Filip ; Captur, Gabriella ; Hundley, W. Gregory ; Liu, Chia Ying ; Moon, James C. ; Petersen, Steffen E. ; Ambale Venkatesh, Bharath ; Lima, Joao ; Bluemke, David A. / Hypertrabeculated left ventricular myocardium in relationship to myocardial function and fibrosis : The multi-ethnic study of atherosclerosis. In: Radiology. 2017 ; Vol. 284, No. 3. pp. 667-675.
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T1 - Hypertrabeculated left ventricular myocardium in relationship to myocardial function and fibrosis

T2 - The multi-ethnic study of atherosclerosis

AU - Kawel-Boehm, Nadine

AU - McClelland, Robyn L.

AU - Zemrak, Filip

AU - Captur, Gabriella

AU - Hundley, W. Gregory

AU - Liu, Chia Ying

AU - Moon, James C.

AU - Petersen, Steffen E.

AU - Ambale Venkatesh, Bharath

AU - Lima, Joao

AU - Bluemke, David A.

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N2 - Purpose: To determine if excess greater left ventricle (LV) trabeculation is associated with decreased average regional myocardial function, diffuse fibrosis, or both. Materials and Methods: This was a HIPAA-compliant institutional board approved multicenter study, and all participants provided written informed consent. Participants in the Multi-Ethnic Study of Atherosclerosis (MESA) underwent a comprehensive cardiac magnetic resonance (MR) examination. LV trabeculation was measured with the maximal apical fractal dimension (FD), which is a marker of endocardial complexity. Demographic covariates, cardiovascular risk factors, and cardiac MR measurements were compared across quartiles of FD. Associations between FD and peak regional systolic circumferential strain (Ecc) and T1 time, a surrogate for diffuse myocardial fibrosis, were assessed with multivariable linear regression models. Results: A total of 1123 subjects (593 [52.8%] female; mean age, 67.1 years ± 8.7 [standard deviation]) underwent FD and Ecc measurement, and 992 (521 [52.5%] female; mean age, 67.1 years ± 8.7) underwent FD and T1 measurement. Mean FD was 1.2 ± 0.07 in both groups, and mean Ecc was 218.3 ± 2.27 in the subjects who underwent FD and Ecc measurement. Global volumes and ejection fraction showed no differences between FD quartiles. However, with increasing FD quartile, Ecc was greater (indicating worse average regional function) (P <.001). After adjustment, greater trabeculation was associated with 21% worse myocardial strain (relative to the mean) per unit change in FD (regression coefficient = 4.0%; P < .001). There was no association between the degree of trabeculation and diffuse fibrosis measured with T1 mapping. Conclusion: Average regional LV function was worse in individuals with greater LV trabeculation, supporting the concept of hypertrabeculation being an epiphenomenon of disease.

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