Gender differences in hypertrophic cardiomyopathy assessed by cardiovascular magnetic resonance feature tracking

Introduction The recognition of gender differences in cardiovascular disease is increasing. Cardiac magnetic resonance imaging (CMR) offers high spatial and temporal resolution images irrespective of body shape and size. This enables precise evaluation of deformational mechanics of cardiac contraction which can be impaired even when the ejection fraction is normal. While previous studies have suggested gender differences using echocardiography speckle-tracking in hypertrophic cardiomyopathy (HCM), there is no similar data on the use of CMR. The aim of the study was to compare cardiac deformation parameters obtained using CMR 3D feature tracking imaging (FTI) for male and female individuals with HCM. Methods Consecutive patients with HCM, LVEF>55% and HCM-related fibrosis were included in the study. CMR FTI parameters included left ventricular (LV) global longitudinal (GLS), circumferential (GCS) and radial (GRS) strain derived from multi-slice 2D cine image stacks in the short LV short axis plane. FTI was calculated using Circle Cvi42 software. Results A total of 28 patients with HCM were included in the analysis, with an equal number of 14 men and 14 women. All patients demonstrated impaired longitudinal, but preserved circumferential and radial deformation parameters as compared to FTI reference values (mean GLS -was of 9.5% ± 3.9, mean GCS of -15.7% ± 8, mean GRS of 36.1% ± 13.5). There were no significant differences in terms of age (69.7 ± 12.2 vs. 63.9 ± 6 years, p=0.14), body mass index, number of hypertrophic segments (4.7 ± 2.7 vs. 4.3 ± 1.4, p=0.6), or number of segments with fibrosis (3.3 ± 2.2 vs. 3.3 ± 1.8) between women and men. When considering standard CMR parameters, women had lower left ventricular end-diastolic volumes (71.1 ± 17.5 ml vs. 87.7 ± 18.3 ml/m2, p=0.02), left ventricular mass (65.4 ± 19.6 vs. 86.1 ±2 9 g/m2, p=0.04), and right ventricular end-diastolic volumes (52.8 ±1 5.4 vs. 75.2 ± 13.3 ml/m2, p=0.0004). The LV and right ventricular (RV) ejection fractions were similar between males and females. Regarding FTI parameters, both GCS (-14.3% ± 9.5 vs. -16% ± 9, p=0.63) and GRS (36.4% ± 10.7 vs. 37.4% ± 8.3, p=0.77) values were similar in both groups. However, women exhibited superior left ventricular systolic function compared to males in terms of GLS (-11.5% ± 2.5 vs. -8.1% ± 5.2, p=0.03). Conclusions HCM patients exhibited gender differences in 3D GLS on feature tracking CMR. This may have clinical relevance as impairment of left ventricular deformation is a powerful indicator of cardiovascular prognosis in hypertrophic cardiomyopathy (HCM), even in the presence of preserved global systolic LV function. GLS 3D differences according to gender.