Myocardial contraction fraction derived from cardiovascular magnetic resonance cine images-reference values and performance in patients with heart failure and left ventricular hypertrophy.
OBJECTIVE
Left ventricular hypertrophy (LVH) has strong prognostic implications and is associated with heart failure. Recently, myocardial contraction fraction (MCF) was identified as a useful marker for specifically identifying cardiac amyloidosis (CA). The purpose of this study was to evaluate the diagnostic accuracy of MCF for the discrimination of different forms of LVH.


RESULTS
We analysed cardiovascular magnetic resonance (CMR) scans of patients with CA (n = 132), hypertrophic cardiomyopathy (HCM, n = 60), hypertensive heart disease (HHD, n = 38) and in 100 age- and gender-matched healthy controls. MCF was calculated by dividing left ventricular (LV) stroke volume by LV myocardial volume. The diagnostic accuracy of MCF was compared to that of LV ejection fraction (EF) and the mass index (MI). Compared with controls (136.3 ± 24.4%, P < 0.05), mean values for MCF were significantly reduced in LVH (HHD:92.6 ± 20%, HCM:80 ± 20.3%, transthyretin CA:74.9 ± 32.2% and light-chain (AL) CA:50.5 ± 21.4%). MCF performed better than LVEF (AUC = 0.96 vs. AUC = 0.6, P < 0.001) and was comparable to LVMI (AUC = 0.95, P = 0.4) in discriminating LVH from controls. There was a significant yet weak correlation between MCF and LVEF (r = 0.43, P < 0.0001). MCF outperformed LVEF and LVMI in discriminating between different etiologies of LVH and between AL and other forms of LVH (AUC = 0.84, P < 0.0001). Moreover, cut-off values for MCF <50% and LVEF <60% allowed to identify patients with high probability for CA.


CONCLUSIONS
In patients with heart failure MCF discriminates CA from other forms of LVH. As it can easily be derived from standard, non-contrast cine images, it may be a very useful marker in the diagnostic workup of patients with LVH.
Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany.|Department of Cardiology, Solothurner Spitäler AG, Kantonsspital Olten, Switzerland.
Nisha
N
Arenja
Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany.
Thomas
T
Fritz
Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany.
Florian
F
Andre
Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany.
Johannes H
JH
Riffel
Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany.
Fabian
F
Aus dem Siepen
Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany.
Marco
M
Ochs
Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany.
Judith
J
Paffhausen
Department of Hematology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany.
Ute
U
Hegenbart
Department of Hematology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany.
Stefan
S
Schönland
Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany.
Matthias
M
Müller-Hennessen
Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany.
Evangelos
E
Giannitsis
Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany.
Arnt V
AV
Kristen
Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany.|DZHK (German Centre for Cardiovascular Research), partner site Heidelberg, Germany.
Hugo A
HA
Katus
Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany.
Matthias G
MG
Friedrich
Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany.|Das Radiologische Zentrum - Radiology Center Sinsheim-Eberbach-Erbach-Walldorf-Heidelberg, Germany.
Sebastian J
SJ
Buss
D000367:Age Factors; D000686:Amyloidosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D019540:Area Under Curve; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003937:Diagnosis, Differential; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D006785:Hospitals, University; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D009200:Myocardial Contraction / Q000502:physiology*; D011379:Prognosis; D012372:ROC Curve; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012737:Sex Factors; D013318:Stroke Volume / Q000502:physiology
cardiac amyloidosis; heart failure; left ventricular ejection fraction; left ventricular hypertrophy; myocardial contraction fraction