Dynamic myocardial strain as a predictor of late gadolinium enhancement in duchenne muscular dystrophy: a longitudinal study

Duchenne muscular dystrophy (DMD) is a prevalent X-linked recessive disorder leading to progressive cardiac complications, particularly myocardial fibrosis. Early detection of myocardial fibrosis is crucial for timely intervention, yet existing studies primarily focus on cross-sectional data.

This study aims to evaluate the dynamic changes in myocardial strain parameters and their predictive value for the occurrence of late gadolinium enhancement (LGE) in DMD patients, hypothesizing that these parameters can serve as non-invasive biomarkers for early detection.

A longitudinal cohort study was conducted from January 2019 to December 2024, involving cardiac magnetic resonance (CMR) assessments of DMD patients at baseline and at 1, 2, 3, and 4 years. Myocardial strain parameters were analyzed to determine their association with LGE development.

Nonlinear mixed-effects models showed significant differences in basal circumferential strain (BCS) and basal radial strain (BRS) trajectories between groups (P<0.05). Changes in BCS and BRS were localized to subepicardial and midmyocardial segments, aligning with LGE-identified fibrosis. Cox regression identified cutoff values of 36.81 for BRS and -18.96 for BCS. Survival curve analysis revealed significant differences at these cutoffs (P<0.05), indicating BRS's potential in predicting LGE.

Dynamic monitoring of myocardial strain parameters, particularly basal radial and circumferential strain, can effectively predict LGE development in DMD patients. These findings underscore the potential of strain imaging as a non-invasive tool for early risk stratification and timely intervention. Future research should focus on validating these findings in larger cohorts and exploring the mechanisms linking myocardial strain changes to fibrosis development.

Differences in Strain Trajectories