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2 Assessment of the microstructure in recovered dilated cardiomyopathy with diffusion tensor cardiovascular magnetic resonance
  1. Zohya Khalique1,2,
  2. Pedro F Ferreira1,2,
  3. Andrew D Scott1,2,
  4. Sonia Nielles-Vallespin2,3,
  5. Rick Wage1,
  6. David N Firmin1,2,
  7. Dudley J Pennell1,2
  1. 1Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
  2. 2National Heart and Lung Institute, Imperial College, London, UK
  3. 3National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA


Introduction Diffusion Tensor Cardiovascular Magnetic Resonance (DT-CMR) assesses myocardial microstructure in vivo, providing information on myocyte and sheetlet organisation. Dilated cardiomyopathy (DCM) patients exhibit impaired sheetlet mobility. Approximately 1/3 DCM patients recover (R-DCM), exhibiting improved left ventricular (LV) size and ejection fraction (EF). However, there has been no study of microstructural recovery in R-DCM.

Methods DT-CMR was performed in 12 DCM, 12 R-DCM, and 12 control subjects. R-DCM patients had normal indexed LV size and EF. A STEAM-EPI sequence with b=150 and b=600 at 3 T was used. LV cardiomyocyte orientation (helix angle, HA), sheetlet orientation (secondary eigenvector angulation, E2A), EF and peak radial strain were calculated. The Mann-Whitney test was used for statistical analysis.

Results Groups were age and sex matched. In R-DCM, median [IQR] EF at baseline was 27[13]% and current EF was 64[7]%. The EF was 33[16]% in DCM, and 66[4]% in controls. Median [IQR] diastolic E2A in R-DCM was 25[9]°, similar to DCM (19[11]°, p=0.11) and controls (20[14]° p=0.24). However, systolic E2A in R-DCM was 59[14]°, significantly greater than DCM (35[17]° (p<0.0001), but lower than controls (65[8]°, p=0.01). E2A mobility was 35[10]° in R-DCM, greater than DCM (9.6[16]°, p<0.0001), but less than controls (46[10]°, p=0.001). Peak radial strain was 0.42 [0.14] in R-DCM, more than DCM, (0.18 [0.17], p=0.002), but less than controls (0.55 [0.17], p=0.009).

Conclusion Despite normal LV size and EF, R-DCM patients have persistent microstructural abnormalities. Sheetlet mobility may offer a role in disease monitoring and assessment of recovery.

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