Analysis of three-chamber view conventional and tagged cine MRI in patients with suspected hypertrophic cardiomyopathy

Objectives To investigate the potential value of adding a tagged three-chamber (3Ch) cine to clinical hypertrophic cardiomyopathy (HCM) magnetic resonance imaging (MRI) protocols, including to help distinguish HCM patients with regionally impaired cardiac function. Methods Forty-eight HCM patients, five patients with “septal knuckle” (SK), and 20 healthy volunteers underwent MRI at 1.5T; a tagged 3Ch cine was added to the protocol. Regional strain, myocardial wall thickness, and mitral valve leaflet lengths were measured in the 3Ch view. Results In HCM, we found a reduced tangential strain with decreased diastolic relaxation in both hypertrophied ( p = 0.003) and remote segments ( p = 0.035). Strain in the basal septum correlated with the length of the coaptation zone + residual leaflet ( r = 0.48, p < 0.001). In the basal free wall, patients with SK had faster relaxation compared to HCM patients with septal hypertrophy. Discussion The 3Ch tagged MRI sequence provides useful information for the examination of suspected HCM patients, with minimal additional time cost. Local wall function is closely associated with morphological changes of the mitral apparatus measured in the same plane and may provide insights into mechanisms of obstruction. The additional strain information may be helpful when analyzing local myocardial wall motion patterns in the presence of SK.