Multiparametric CMR evaluation of myocardial remodeling in dystrophinopathy

Figures

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  Figure 1. Study enrollment, flow diagram of participant selection, and subgroup stratification. The flow diagram summarizes screening, inclusion, exclusion, and final subgroup allocation of both controls and patients with dystrophinopathy. CMR, cardiac magnetic resonance; LGE, late gadolinium enhancement; LVEF, left ventricular ejection fraction.

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  Figure 2. Abnormal CMR parameters in dystrophinopathy compared with controls. (A–D) RS at global, basal, mid, and apical levels; (E–H) CS at global, basal, mid, and apical levels; (I–L) LS at global, basal, mid, and apical levels; (M) LVEF; (N–P) native T1 values at segments 5, 6, and 11, corresponding to basal inferolateral, basal anterolateral, and mid-inferolateral segments, respectively. *p < .05, **p < .01, ***p < .001, ****p < .0001. CMR, cardiac magnetic resonance; Con, control; CS, circumferential strain; LS, longitudinal strain; LVEF, left ventricular ejection fraction; ns, not significant; RS, radial strain.

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  Figure 3. Major differential CMR parameters and discriminatory performance across controls, group A, and group B. (A) LASSO logistic regression with 10-fold cross-validation was performed. (B) CS at middle level, (C) native T1 value at segment 11 (corresponding to mid-inferolateral segment), (D) Spearman correlation heatmap among candidate CMR variables, and (E) ROC curves for discriminating Group B from Group A. *p < .05, **p < .01, ***p < .001, ****p < .0001. BSA, body surface area; CMR, cardiac magnetic resonance; Con, control; CS, circumferential strain; LS, longitudinal strain; LVEF, left ventricular ejection fraction; MyoMass, myocardial mass; ns, not significant; ROC, receiver operating characteristic; RS, radial strain.

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  Figure 4. Major differential CMR parameters and discriminatory performance across controls, group C, and group D. (A) LASSO logistic regression with 10-fold cross-validation was performed. (B) CS at global level, (C) native T1 value at segment 5 (corresponding to basal inferolateral segment), (D) the heatmap displays pairwise Spearman correlation coefficients among main CMR variables, and (E) ROC curves based on predicted probabilities from the age-adjusted logistic model to discriminate Group C from Group D. *p < .05, **p < .01, ***p < .001, ****p < .0001. CMR, cardiac magnetic resonance; Con, control; CS, circumferential strain; LS, longitudinal strain; LVEF, left ventricular ejection fraction; MyoMass, myocardial mass; ns, not significant; ROC, receiver operating characteristic; RS, radial strain.

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  Figure 5. Representative CMR images and myocardial strain analysis in an 11-year-old male patient with dystrophinopathy and negative late gadolinium enhancement (LGE). (A–C) Cine images in the left ventricular short-axis, four-chamber, and three-chamber views, respectively. (D–F) Sixteen-segment bull's-eye plots of radial strain (RS), circumferential strain (CS), and longitudinal strain (LS), respectively. (G–I) Corresponding myocardial strain curves for RS, CS, and LS, respectively.

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  Figure 6. Representative CMR images and myocardial strain analysis in a 15-year-old male patient with dystrophinopathy and positive late gadolinium enhancement (LGE). (A–C) Cine images in the left ventricular short-axis, two-chamber, and three-chamber views, respectively. (D–F) Sixteen-segment bull's-eye plots of radial strain (RS), circumferential strain (CS), and longitudinal strain (LS), respectively. (G–I) Corresponding myocardial strain curves for RS, CS, and LS, respectively.