Non-ischemic Primary and Secondary Cardiomyopathy

1355885 - Inclusion of papillary muscle mass and trabeculations in left ventricular assessment correlates more closely to total LVM in diseases of left ventricular hypertrophy.

Wednesday, January 25, 2023

Location: E-POSTER

Presenting Author(s)

HK

Hibba Kurdi, MD, BSc

Cardiology Fellow
Barts Health NHS Trust, London, UK
London, United Kingdom

Primary Author(s)

HK

Hibba Kurdi, MD, BSc

Cardiology Fellow
Barts Health NHS Trust, London, UK
London, United Kingdom

Co-Author(s)

GT

George D. Thornton, MBBS

Clinical Research Fellow
University College London, United Kingdom
JA

Jessica Artico, MD

Clinical Research Fellow
St Bartholomew's Hospital, England, United Kingdom
AA

Aderonke T. Abiodun, MBChB

Clinical Research Fellow
University College London, United Kingdom
KP

Kush P. Patel, MD

Cardiologist Registrar
Barts Heart Centre, United Kingdom
HS

Hunain Shiwani, MD

Clinical Research Fellow
University College London and Barts Heart Centre, United Kingdom
Rebecca Kozor, MD, PhD

Cardiologist
Royal North Shore Hospital
Sydney, New South Wales, Australia
Marianna Fontana, MD, PhD

Consultant Cardiologist, Director UCL CMR unit at the RFH
University College London
London, England, United Kingdom
RS

Richard P. P. Steeds, MD

Honorary Professor of Cardiovascular Medicine
University of Birmingham
Birmingham, England, United Kingdom
HX

Hui Xue, PhD

Director, Imaging AI Program
National Institutes of Health
Bethesda, Maryland, United States
PK

Peter Kellman, PhD

Senior Scientist
National Institutes of Health, Maryland, United States
Thomas A. Treibel, MD, PhD

Consultant Cardiologist
University College London, England, United Kingdom
Charlotte Manisty

Consultant Cardiologist
University College London and Barts Heart Centre
London, England, United Kingdom
James C. Moon, MD

Clinical Director, Imaging
Barts Heart Centre and UCL
London, England, United Kingdom
Rhodri Davies, MD, PhD

Associate clinical professor
University College London
London, Wales, United Kingdom

Disclosure(s):

Marianna Fontana, MD, PhD: No relevant disclosure to display

Thomas A. Treibel, MD, PhD: No relevant disclosure to display

Charlotte Manisty: No relevant disclosure to display

Background: Papillary muscles and trabeculae are prominent/hypertrophied in diseases such as Fabry disease (FD) and hypertrophic cardiomyopathy (HCM)¹ so their assessment in CMR volumetric analysis may be important. Smooth contours are considered more precise and reproducible^2,3 but they omit the contribution of papillary muscles and trabeculae. This may be reasonable – if the papillary muscles/trabecular contribution to LV mass (LVM) are a fixed bias with no disease specific relative contribution. This study aims to investigate whether the papillary muscle/trabeculae contribution to LV mass varies with disease.

Methods: 378 patients were prospectively recruited for disease specific research and here amalgamated for this retrospective analysis: 72 healthy volunteers (HV), 124 HCM, 122 FD and 26 Transthyretin (TTR) Amyloid. Each was analysed using two artificial intelligence (AI) approaches: a smooth model and a trabeculated model to determine LV end diastolic, end systolic, LVM, stroke volume and ejection fraction (LVEF). Papillary muscle/trabecular mass was then calculated by the difference in mass between trabeculated and smooth models (VM_Trab-LVM_Sm), expressed as a percentage of total LVM.

Results: For the disease cohorts, expected differences were present in all volumetric parameters compared to controls. Mean papillary mass and overall contribution to LVM varied with disease: highest in TTR amyloid (29g, IQR:25-33g), followed by HCM (20g, IQR:15-27g) and Fabry (10g, IQR: 7-19g), HV (7g, IQR: 5-10g); making up 12%, 10%,9% and 7% of total LV mass respectively. These relative proportions remained present even in LVH negative disease patients.

Conclusion:

Papillary muscles and trabeculae hypertrophy disproportionately in a broader range of diseases than previously anticipated. In the choice between trabeculated vs smooth models for LV analysis, this seems an added reason to prioritise trabeculated approaches.