Quantitative assessment of myocardial dysfunction in mild focal left ventricular hypertrophy using CMR feature tracking.

Objectives

This study aimed to investigate cardiac dysfunction in patients with mild focal left ventricular hypertrophy (MF-LVH) by analyzing the left ventricular (LV) and left atrial (LA) deformation parameters derived from cardiac magnetic resonance feature tracking (CMR-FT).

Methods

This retrospective study included 36 patients with MF-LVH, 44 patients with HCM without late gadolinium enhancement (HCM-non-LGE), and 32 healthy controls who were examined between November 2020 and August 2025. The LA and LV strain parameters were obtained using CMR-FT. Statistical comparisons, multivariable logistic regression, and receiver operating characteristic (ROC) curve analyses were conducted.

Results

While conventional parameters showed no difference, all global LV strains and most strain rate parameters were significantly impaired in both patient groups, showing a stepwise decline with advancing hypertrophy severity. In multivariable analyses, the peak diastolic radial strain rate (PD-RSR) was the primary discriminator distinguishing MF-LVH from controls, and LV global longitudinal strain (LV-GLS) was the key discriminator differentiating MF-LVH from HCM-non-LGE. LV-GLS and LA minimal volume index (LAVImin) were the key discriminators for HCM-non-LGE versus controls. ROC analysis confirmed LV-GLS as an excellent discriminator (AUC 0.85 for MF-LVH vs. HCM-non-LGE; AUC 0.96 for HCM-non-LGE vs. controls), with notably similar optimal cutoff values (-13.94% and -13.99%, respectively). PD-RSR showed good accuracy in identifying MF-LVH.

Conclusion

PD-RSR indicates early diastolic impairment, and LV-GLS sensitively detects systolic dysfunction in patients with MF-LVH. The overlapping LV-GLS values between patients with MF-LVH and HCM-non-LGE suggest a potential pathophysiological continuum. CMR-FT enables early detection of subclinical myocardial dysfunction in this population.