Author + information
- Received November 6, 2018
- Revision received July 9, 2019
- Accepted July 11, 2019
- Published online May 4, 2020.
- Zohya Khalique, MDa,b,
- Pedro F. Ferreira, PhDa,b,
- Andrew D. Scott, PhDa,b,
- Sonia Nielles-Vallespin, PhDa,b,
- David N. Firmin, PhDa,b and
- Dudley J. Pennell, MDa,b,∗ ()
- aCMR Unit, Royal Brompton Hospital, London, United Kingdom
- bNational Heart and Lung Institute, Imperial College, London, United Kingdom
- ↵∗Address for correspondence:
Prof. Dudley Pennell, CMR Unit, Royal Brompton Hospital, London SW3 6NP, United Kingdom.
• DT-CMR is a unique technique for noninvasive assessment of myocardial microstructure.
• DT-CMR has identified novel cardiomyocyte and sheetlet abnormalities in cardiac disease in vivo.
• DT-CMR has the potential to aid clinical diagnosis and risk stratification through microscopic phenotyping.
Imaging the heart is central to cardiac phenotyping, but in clinical practice, this has been restricted to macroscopic interrogation. Diffusion tensor cardiovascular magnetic resonance (DT-CMR) is a novel, noninvasive technique that is beginning to unlock details of this microstructure in humans in vivo. DT-CMR demonstrates the helical cardiomyocyte arrangement that drives rotation and torsion. Sheetlets (functional units of cardiomyocytes, separated by shear layers) have been shown to reorientate between diastole and systole, revealing how microstructural function facilitates cardiac thickening. Measures of tissue diffusion can also be made: fractional anisotropy (a measure of myocyte organization) and mean diffusivity (a measure of myocyte packing). Abnormal myocyte orientation and sheetlet function has been demonstrated in congenital heart disease, cardiomyopathy, and after myocardial infarction. It is too early to predict the clinical importance of DT-CMR, but such unique in vivo information will likely prove valuable in early diagnosis and risk prediction of cardiac dysfunction and arrhythmias.
Dr. Scott has received an equipment grant from NVIDIA. Dr. Firmin and Prof. Pennell have received research support from Siemens. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Imaging author instructions page.
- Received November 6, 2018.
- Revision received July 9, 2019.
- Accepted July 11, 2019.
- 2020 American College of Cardiology Foundation
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