Association Between Myocardial Oxygenation and Fibrosis in Duchenne Muscular Dystrophy: Analysis by Rest Oxygenation‐Sensitive Magnetic Resonance Imaging

• Published in: Journal of magnetic resonance imaging Vol. 60; no. 5; pp. 1989 - 1999
• Main Authors: Zhou, Ziqi, Xu, Rong, Cai, Xiaotang, Fu, Hang, Xu, Ke, Yuan, Weifeng, Song, Yu, Shi, Ke, Fu, Chuan, Li, Xuesheng, Wang, Chuan, Guo, Yingkun, Yu, Li, Xu, Huayan
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.11.2024; Wiley Subscription Services, Inc
• Subjects: Adolescent; Biomarkers; Bivariate analysis; Cardiomyopathies - diagnostic imaging; Cardiomyopathy; Child; Damage assessment; Data recovery; Duchenne muscular dystrophy; Duchenne's muscular dystrophy; Dystrophy; Fibrosis; Fibrosis - diagnostic imaging; Field strength; Functional magnetic resonance imaging; Heart; Heart - diagnostic imaging; Humans; Hypoxia; Hypoxia - diagnostic imaging; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medical imaging; Multivariable control; Muscular dystrophy; Muscular Dystrophy, Duchenne - complications; Muscular Dystrophy, Duchenne - diagnostic imaging; myocardial hypoxia; Myocardium - metabolism; Myocardium - pathology; Oxygen - metabolism; Oxygenation; oxygenation‐sensitive cardiac magnetic resonance imaging; Performance assessment; Prospective Studies; Recovery of function; Rest; Segments; Sensitivity analysis; Statistical analysis; Statistical tests; Variance analysis; fibrosis; Duchenne muscular dystrophy; oxygenation‐sensitive cardiac magnetic resonance imaging; myocardial hypoxia
• ISSN: 1053-1807; 1522-2586; 1522-2586
• DOI: 10.1002/jmri.29273

Background Myocardial hypoxia has been demonstrated in many cardiomyopathies and is related to development of myocardial fibrosis. However, myocardial hypoxia and its association with myocardial fibrosis are understudied in Duchenne muscular dystrophy (DMD)‐associated cardiomyopathy. Purpose To evaluate myocardial hypoxia by oxygenation‐sensitive (OS) cardiac magnetic resonance imaging, and further explore its association with fibrosis. Study Type Prospective. Subjects Ninety‐one DMD boys (8.78 ± 2.32) and 30 healthy boys (9.07 ± 2.30). Field Strength/Sequence 3 T, Balanced steady‐state free procession, Modified Look‐Locker inversion recovery sequence and Single‐shot phase‐sensitive inversion recovery sequence. Assessment Cardiac MRI data, including left ventricular functional, segmental native T1, and oxygenation signal‐intensity (SI) according to AHA 17‐segment model, were acquired. Patients were divided into LGE+ and LGE− groups. In patients with LGE, all segments were further classified as positive or negative segments by segmentally presence/absence of LGE. Statistical Tests Variables were compared using Student's t, Wilcoxon, Kruskal–Wallis test and one‐way analysis of variance. Bivariate Pearson or Spearman correlation were calculated to determine association between oxygenation SI and native T1. Variables with P < 0.10 in the univariable analysis were included in multivariable model. Receiver operating characteristic analysis was used to assess the performance of OS in diagnosing myocardial hypoxia. Results The myocardial oxygenation SI of DMD was significantly decreased in all segments compared with normal controls, and more obvious in the LGE+ segments (0.46 ± 0.03 vs. 0.52 ± 0.03). For patients with and without LGE, myocardial oxygenation SI were significantly negatively correlated with native T1 in all segments (r = −0.23 to −0.42). The inferolateral oxygenation SI was a significant independent associator of LGE presence (adjusted OR = 0.900). Data Conclusion Myocardial hypoxia evaluated by the OS‐Cardiac‐MRI indeed occurs in DMD and associate with myocardial fibrosis, which might be used as a biomarker in assessing myocardial damage in DMD. Evidence Level 1 Technical Efficacy Stage 1