LGE-CMR-derived texture features reflect poor prognosis in hypertrophic cardiomyopathy patients with systolic dysfunction: preliminary results

Objectives: To evaluate the prognostic value of texture features based on late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) images in hypertrophic cardiomyopathy (HCM) patients with systolic dysfunction. Methods: 67 HCM patients with systolic dysfunction (41 male and 26 female, mean age ± standard deviation, 46.20 years ± 13.38) were enrolled. All patients underwent 1.5 T CMR cine and LGE imaging. Texture features were extracted from LGE images. Cox proportional hazard analysis and Kaplan-Meier analysis were used to determine the association of texture features and traditional parameters with event free survival. Results: Family history (hazard ratio [HR]=2.558, 95 % confidence interval [CI]=1.060–6.180), NYHA III-IV (HR=5.627, CI=1.652–19.173), left ventricular ejection fraction (HR=0.945, CI=0.902–0.991), left ventricular end-diastolic volume index (HR=1.006, CI=1.000–1.012), LGE extent (HR=1.911, CI=1.348–2.709) and three texture parameters [X0_H_skewness (HR=0.783, CI=0.691–0.889), X0_GLCM_cluster_tendency (HR=0.735, CI=0.616–0.877) and X0_GLRLM_energy (HR=1.344, CI=1.173–1.540)] were significantly associated with event free survival in univariate analysis (p<0.05). The HR of LGE extent (HR=1.548 [CI=1.046–2.293], 1.650 [CI=1.122–2.428] and 1.586 [CI=1.044–2.409] per 10 % increase, p<0.05) remained significant when adjusted by one of the three texture features. Conclusion: Increased LGE heterogeneity (higher X0_GLRLM_energy, lower X0_H_skewness and lower X0_GLCM_cluster_tendency) was associated with adverse events in HCM patients with systolic dysfunction. Key Points: • Textural analysis from CMR can be applied in HCM. • Texture features derived from LGE images can capture fibrosis heterogeneity. • CMR texture analysis provides prognostic information in HCM patients.