title: Fractal Analysis of Myocardial Trabeculations in 2547 Study Participants: Multi-Ethnic Study of Atherosclerosis.
abstract: OBJECTIVE
  To quantitatively determine the population variation and relationship of left ventricular (LV) trabeculation to LV function, structure, and clinical variables.
  
  
  METHODS
  This HIPAA-compliant multicenter study was approved by institutional review boards of participating centers. All participants provided written informed consent. Participants from the Multi-Ethnic Study of Atherosclerosis with cardiac magnetic resonance (MR) data were evaluated to quantify LV trabeculation as a fractal dimension (FD). Entire cohort participants free of cardiac disease, hypertrophy, hypertension, and diabetes were stratified by body mass index (BMI) into three reference groups (BMI <25 kg/m(2); BMI ≥25 kg/m(2) to <30 kg/m(2); and BMI ≥30 kg/m(2)) to explore maximal apical FD (FDMaxApical). Multivariable linear regression models determined the relationship between FD and other parameters.
  
  
  RESULTS
  Included were 2547 participants (mean age, 68.7 years ± 9.1 [standard deviation]; 1211 men). FDMaxApical are in arbitrary units. FDMaxApical reference ranges for BMI 30 kg/m(2) or greater (n = 163), 25 kg/m(2) or greater to less than 30 kg/m(2) (n = 206), and less than 25 kg/m(2) (n = 235) were 1.203 ± 0.06 (95% confidence interval: 1.194, 1.212), 1.194 ± 0.06 (95% confidence interval: 1.186, 1.202), and 1.169 ± 0.05 (95% confidence interval: 1.162, 1.176), respectively. In the entire cohort, adjusted for anthropometrics, trabeculation was higher in African American participants (standardized β [sβ] = 0.09; P ≤ .001) and Hispanic participants (sβ = 0.05; P = .013) compared with white participants and was also higher in African American participants compared with Chinese American participants (sβ = 0.08; P = .01), and this persisted after adjustment for hypertension and LV size. Hypertension (sβ = 0.07; P < .001), LV mass (sβ = 0.22; P < .001), and wall thickness (sβ = 0.27; P < .001) were positively associated with FDMaxApical even after adjustment. In the group with BMIs less than 25 kg/m(2), Chinese American participants had less trabeculation than white participants (sβ = -0.15; P = .032).
  
  
  CONCLUSIONS
  Fractal analysis of cardiac MR imaging data measures endocardial complexity, which helps to differentiate normal from abnormal trabecular patterns in healthy versus diseased hearts. Trabeculation is influenced by race and/or ethnicity and, more importantly, by cardiac loading conditions and comorbidities. Clinicians who interpret cine MR imaging data should expect slightly less endocardial complexity in Chinese American patients and more in African American patients, Hispanic patients, hypertensive patients, and those with hypertrophy.
authors.affiliation: From the Division of Cardiovascular Imaging and Biostatistics, The Heart Hospital, 16-18 Westmoreland Street, London, England, W1G 8PH (G.C., P.B., W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science, University College London, London, England (G.C., V.M., W.J.M., P.M.E., J.C.M.); Cardiovascular Biomedical Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, England (F.Z., S.E.P.); Division of Cardiovascular Imaging, The London Chest Hospital, London, England (F.Z., S.E.P.); UCL Center for Cardiovascular Imaging and Great Ormond Street Hospital for Children, London, England (V.M.); Department of Radiology, University of Pennsylvania, Philadelphia, Pa (C.L.); Department of Radiology, Hospital Graubuenden, Loestrasse, Switzerland (N.K.B.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (J.A.C.L., D.A.B.); and Department of Cardiovascular Imaging, Johns Hopkins Hospital, Baltimore, Md (D.A.B.).
authors.forename: Gabriella
authors.initials: G
authors.lastname: Captur
authors.affiliation: From the Division of Cardiovascular Imaging and Biostatistics, The Heart Hospital, 16-18 Westmoreland Street, London, England, W1G 8PH (G.C., P.B., W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science, University College London, London, England (G.C., V.M., W.J.M., P.M.E., J.C.M.); Cardiovascular Biomedical Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, England (F.Z., S.E.P.); Division of Cardiovascular Imaging, The London Chest Hospital, London, England (F.Z., S.E.P.); UCL Center for Cardiovascular Imaging and Great Ormond Street Hospital for Children, London, England (V.M.); Department of Radiology, University of Pennsylvania, Philadelphia, Pa (C.L.); Department of Radiology, Hospital Graubuenden, Loestrasse, Switzerland (N.K.B.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (J.A.C.L., D.A.B.); and Department of Cardiovascular Imaging, Johns Hopkins Hospital, Baltimore, Md (D.A.B.).
authors.forename: Filip
authors.initials: F
authors.lastname: Zemrak
authors.affiliation: From the Division of Cardiovascular Imaging and Biostatistics, The Heart Hospital, 16-18 Westmoreland Street, London, England, W1G 8PH (G.C., P.B., W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science, University College London, London, England (G.C., V.M., W.J.M., P.M.E., J.C.M.); Cardiovascular Biomedical Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, England (F.Z., S.E.P.); Division of Cardiovascular Imaging, The London Chest Hospital, London, England (F.Z., S.E.P.); UCL Center for Cardiovascular Imaging and Great Ormond Street Hospital for Children, London, England (V.M.); Department of Radiology, University of Pennsylvania, Philadelphia, Pa (C.L.); Department of Radiology, Hospital Graubuenden, Loestrasse, Switzerland (N.K.B.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (J.A.C.L., D.A.B.); and Department of Cardiovascular Imaging, Johns Hopkins Hospital, Baltimore, Md (D.A.B.).
authors.forename: Vivek
authors.initials: V
authors.lastname: Muthurangu
authors.affiliation: From the Division of Cardiovascular Imaging and Biostatistics, The Heart Hospital, 16-18 Westmoreland Street, London, England, W1G 8PH (G.C., P.B., W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science, University College London, London, England (G.C., V.M., W.J.M., P.M.E., J.C.M.); Cardiovascular Biomedical Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, England (F.Z., S.E.P.); Division of Cardiovascular Imaging, The London Chest Hospital, London, England (F.Z., S.E.P.); UCL Center for Cardiovascular Imaging and Great Ormond Street Hospital for Children, London, England (V.M.); Department of Radiology, University of Pennsylvania, Philadelphia, Pa (C.L.); Department of Radiology, Hospital Graubuenden, Loestrasse, Switzerland (N.K.B.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (J.A.C.L., D.A.B.); and Department of Cardiovascular Imaging, Johns Hopkins Hospital, Baltimore, Md (D.A.B.).
authors.forename: Steffen E
authors.initials: SE
authors.lastname: Petersen
authors.affiliation: From the Division of Cardiovascular Imaging and Biostatistics, The Heart Hospital, 16-18 Westmoreland Street, London, England, W1G 8PH (G.C., P.B., W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science, University College London, London, England (G.C., V.M., W.J.M., P.M.E., J.C.M.); Cardiovascular Biomedical Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, England (F.Z., S.E.P.); Division of Cardiovascular Imaging, The London Chest Hospital, London, England (F.Z., S.E.P.); UCL Center for Cardiovascular Imaging and Great Ormond Street Hospital for Children, London, England (V.M.); Department of Radiology, University of Pennsylvania, Philadelphia, Pa (C.L.); Department of Radiology, Hospital Graubuenden, Loestrasse, Switzerland (N.K.B.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (J.A.C.L., D.A.B.); and Department of Cardiovascular Imaging, Johns Hopkins Hospital, Baltimore, Md (D.A.B.).
authors.forename: Chunming
authors.initials: C
authors.lastname: Li
authors.affiliation: From the Division of Cardiovascular Imaging and Biostatistics, The Heart Hospital, 16-18 Westmoreland Street, London, England, W1G 8PH (G.C., P.B., W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science, University College London, London, England (G.C., V.M., W.J.M., P.M.E., J.C.M.); Cardiovascular Biomedical Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, England (F.Z., S.E.P.); Division of Cardiovascular Imaging, The London Chest Hospital, London, England (F.Z., S.E.P.); UCL Center for Cardiovascular Imaging and Great Ormond Street Hospital for Children, London, England (V.M.); Department of Radiology, University of Pennsylvania, Philadelphia, Pa (C.L.); Department of Radiology, Hospital Graubuenden, Loestrasse, Switzerland (N.K.B.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (J.A.C.L., D.A.B.); and Department of Cardiovascular Imaging, Johns Hopkins Hospital, Baltimore, Md (D.A.B.).
authors.forename: Paul
authors.initials: P
authors.lastname: Bassett
authors.affiliation: From the Division of Cardiovascular Imaging and Biostatistics, The Heart Hospital, 16-18 Westmoreland Street, London, England, W1G 8PH (G.C., P.B., W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science, University College London, London, England (G.C., V.M., W.J.M., P.M.E., J.C.M.); Cardiovascular Biomedical Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, England (F.Z., S.E.P.); Division of Cardiovascular Imaging, The London Chest Hospital, London, England (F.Z., S.E.P.); UCL Center for Cardiovascular Imaging and Great Ormond Street Hospital for Children, London, England (V.M.); Department of Radiology, University of Pennsylvania, Philadelphia, Pa (C.L.); Department of Radiology, Hospital Graubuenden, Loestrasse, Switzerland (N.K.B.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (J.A.C.L., D.A.B.); and Department of Cardiovascular Imaging, Johns Hopkins Hospital, Baltimore, Md (D.A.B.).
authors.forename: Nadine
authors.initials: N
authors.lastname: Kawel-Boehm
authors.affiliation: From the Division of Cardiovascular Imaging and Biostatistics, The Heart Hospital, 16-18 Westmoreland Street, London, England, W1G 8PH (G.C., P.B., W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science, University College London, London, England (G.C., V.M., W.J.M., P.M.E., J.C.M.); Cardiovascular Biomedical Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, England (F.Z., S.E.P.); Division of Cardiovascular Imaging, The London Chest Hospital, London, England (F.Z., S.E.P.); UCL Center for Cardiovascular Imaging and Great Ormond Street Hospital for Children, London, England (V.M.); Department of Radiology, University of Pennsylvania, Philadelphia, Pa (C.L.); Department of Radiology, Hospital Graubuenden, Loestrasse, Switzerland (N.K.B.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (J.A.C.L., D.A.B.); and Department of Cardiovascular Imaging, Johns Hopkins Hospital, Baltimore, Md (D.A.B.).
authors.forename: William J
authors.initials: WJ
authors.lastname: McKenna
authors.affiliation: From the Division of Cardiovascular Imaging and Biostatistics, The Heart Hospital, 16-18 Westmoreland Street, London, England, W1G 8PH (G.C., P.B., W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science, University College London, London, England (G.C., V.M., W.J.M., P.M.E., J.C.M.); Cardiovascular Biomedical Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, England (F.Z., S.E.P.); Division of Cardiovascular Imaging, The London Chest Hospital, London, England (F.Z., S.E.P.); UCL Center for Cardiovascular Imaging and Great Ormond Street Hospital for Children, London, England (V.M.); Department of Radiology, University of Pennsylvania, Philadelphia, Pa (C.L.); Department of Radiology, Hospital Graubuenden, Loestrasse, Switzerland (N.K.B.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (J.A.C.L., D.A.B.); and Department of Cardiovascular Imaging, Johns Hopkins Hospital, Baltimore, Md (D.A.B.).
authors.forename: Perry M
authors.initials: PM
authors.lastname: Elliott
authors.affiliation: From the Division of Cardiovascular Imaging and Biostatistics, The Heart Hospital, 16-18 Westmoreland Street, London, England, W1G 8PH (G.C., P.B., W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science, University College London, London, England (G.C., V.M., W.J.M., P.M.E., J.C.M.); Cardiovascular Biomedical Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, England (F.Z., S.E.P.); Division of Cardiovascular Imaging, The London Chest Hospital, London, England (F.Z., S.E.P.); UCL Center for Cardiovascular Imaging and Great Ormond Street Hospital for Children, London, England (V.M.); Department of Radiology, University of Pennsylvania, Philadelphia, Pa (C.L.); Department of Radiology, Hospital Graubuenden, Loestrasse, Switzerland (N.K.B.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (J.A.C.L., D.A.B.); and Department of Cardiovascular Imaging, Johns Hopkins Hospital, Baltimore, Md (D.A.B.).
authors.forename: João A C
authors.initials: JA
authors.lastname: Lima
authors.affiliation: From the Division of Cardiovascular Imaging and Biostatistics, The Heart Hospital, 16-18 Westmoreland Street, London, England, W1G 8PH (G.C., P.B., W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science, University College London, London, England (G.C., V.M., W.J.M., P.M.E., J.C.M.); Cardiovascular Biomedical Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, England (F.Z., S.E.P.); Division of Cardiovascular Imaging, The London Chest Hospital, London, England (F.Z., S.E.P.); UCL Center for Cardiovascular Imaging and Great Ormond Street Hospital for Children, London, England (V.M.); Department of Radiology, University of Pennsylvania, Philadelphia, Pa (C.L.); Department of Radiology, Hospital Graubuenden, Loestrasse, Switzerland (N.K.B.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (J.A.C.L., D.A.B.); and Department of Cardiovascular Imaging, Johns Hopkins Hospital, Baltimore, Md (D.A.B.).
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
authors.affiliation: From the Division of Cardiovascular Imaging and Biostatistics, The Heart Hospital, 16-18 Westmoreland Street, London, England, W1G 8PH (G.C., P.B., W.J.M., P.M.E., J.C.M.); UCL Institute of Cardiovascular Science, University College London, London, England (G.C., V.M., W.J.M., P.M.E., J.C.M.); Cardiovascular Biomedical Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, England (F.Z., S.E.P.); Division of Cardiovascular Imaging, The London Chest Hospital, London, England (F.Z., S.E.P.); UCL Center for Cardiovascular Imaging and Great Ormond Street Hospital for Children, London, England (V.M.); Department of Radiology, University of Pennsylvania, Philadelphia, Pa (C.L.); Department of Radiology, Hospital Graubuenden, Loestrasse, Switzerland (N.K.B.); Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (J.A.C.L., D.A.B.); and Department of Cardiovascular Imaging, Johns Hopkins Hospital, Baltimore, Md (D.A.B.).
authors.forename: James C
authors.initials: JC
authors.lastname: Moon
mesh_terms: D001741:Black or African American; D000886:Anthropometry; D001213:Asian; D050197:Atherosclerosis / Q000473:pathology*; D005006:Ethnicity; D014644:Genetic Variation; D006352:Heart Ventricles; D006630:Hispanic or Latino; D006801:Humans; D008279:Magnetic Resonance Imaging; D009206:Myocardium / Q000166:cytology / Q000473:pathology*; D044465:White People