Korean J Radiol.  2015 Feb;16(1):4-12. 10.3348/kjr.2015.16.1.4.

Effect of Papillary Muscles and Trabeculae on Left Ventricular Measurement Using Cardiovascular Magnetic Resonance Imaging in Patients with Hypertrophic Cardiomyopathy

• Park EA
• Lee W
• Kim HK
• Chung JW

• KMID: 2069980
• DOI: http://doi.org/10.3348/kjr.2015.16.1.4

Abstract

OBJECTIVE
To evaluate the influence of papillary muscles and trabeculae on left ventricular (LV) cardiovascular magnetic resonance (CMR) analysis using three methods of cavity delineation (classic or modified inclusion methods, and the exclusion method) in patients with hypertrophic cardiomyopathy (HCM).
MATERIALS AND METHODS
This retrospective study included 20 consecutive HCM patients who underwent 1.5-T CMR imaging with short-axis cine stacks of the entire LV. LV measurements were performed using three different methods of manual cavity delineation of the endocardial and epicardial contours: method A, presumed endocardial boundary as seen on short-axis cine images; method B, including solely the cavity and closely adjacent trabeculae; or method C, excluding papillary muscles and trabeculae. Ascending aorta forward flow was measured as reference for LV-stroke volume (SV). Interobserver reproducibility was assessed using intraclass correlation coefficients.
RESULTS
Method A showed larger end-diastole and end-systole volumes (largest percentage differences of 25% and 68%, respectively, p < 0.05), compared with method C. The ejection fraction was 55.7 +/- 6.9% for method A, 68.6 +/- 8.4% for B, and 71.7 +/- 7.0% for C (p < 0.001). Mean mass was also significantly different: 164.6 +/- 47.4 g for A, 176.5 +/- 50.5 g for B, and 199.6 +/- 53.2 g for C (p < 0.001). LV-SV error was largest with method B (p < 0.001). No difference in interobserver agreement was observed (p > 0.05).
CONCLUSION
In HCM patients, LV measurements are strikingly different dependent on whether papillary muscles and trabeculae are included or excluded. Therefore, a consistent method of LV cavity delineation may be crucial during longitudinal follow-up to avoid misinterpretation and erroneous clinical decision-making.

Keyword

Cardiomyopathy, hypertrophic; Magnetic resonance imaging, cine; Ventricular function, left; Papillary muscles; Measurement accuracy, dimensional

MeSH Terms

Adult
Aged
Cardiomyopathy, Hypertrophic/*pathology
Female
Heart Ventricles/physiopathology/*radiography
Humans
*Magnetic Resonance Imaging, Cine
Male
Middle Aged
Papillary Muscles/*physiopathology
Retrospective Studies
Stroke Volume/physiology
Systole/physiology

Figure

• 

  Fig. 1 End-systole (ES) and end-diastole (ED) cine MR images in 54-year-old man with hypertrophic cardiomyopathy. Trabeculae are hypertrophied and abundant, and are difficult to discern from compact myocardium at ES phase.

• 

  Fig. 2 Representative example of endocardial contouring using three methods in 51-year-old man with hypertrophic cardiomyopathy. Method A indicates classic method for inclusion of trabeculae in left ventricular (LV) cavity volume. Single short-axis-view true FISP MR images at end-diastolic (ED) and end-systolic (ES) phases show inclusion of trabeculae in LV cavity volume. Method B includes closely adjacent trabeculae in LV cavity volume. ES image shows inclusion of trabeculae in LV cavity volume similar to method A. However, endocardial contour is smaller, based solely on cavity and closely adjacent trabeculae. Method C indicates classic method for exclusion of trabeculae from LV cavity volume. Trabeculae were completely excluded from cavity volume.

• 

  Fig. 3 Bar graphs showing mean values of left ventricular measures using three different methods. Vertical lines indicate standard error. A. End-diastolic volume (EDV). B. End-systolic volume (ESV). C. Stroke volume (SV). D. Ejection fraction (EF). E. Myocardial mass.

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