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Batra A, Barnard AM, Lott DJ, Willcocks RJ, Forbes SC, Chakraborty S, Daniels MJ, Arbogast J, Triplett W, Henricson EK, Dayan JG, Schmalfuss C, Sweeney L, Byrne BJ, McDonald CM, Vandenborne K, Walter GA. Longitudinal changes in cardiac function in Duchenne muscular dystrophy population as measured by magnetic resonance imaging. BMC Cardiovasc Disord 2022; 22:260. [PMID: 35681116 PMCID: PMC9185987 DOI: 10.1186/s12872-022-02688-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 05/19/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The lack of dystrophin in cardiomyocytes in Duchenne muscular dystrophy (DMD) is associated with progressive decline in cardiac function eventually leading to death by 20-40 years of age. The aim of this prospective study was to determine rate of progressive decline in left ventricular (LV) function in Duchenne muscular dystrophy (DMD) over 5 years. METHODS Short axis cine and grid tagged images of the LV were acquired in individuals with DMD (n = 59; age = 5.3-18.0 years) yearly, and healthy controls at baseline (n = 16, age = 6.0-18.3 years) on a 3 T MRI scanner. Grid-tagged images were analyzed for composite circumferential strain (ℇcc%) and ℇcc% in six mid LV segments. Cine images were analyzed for left ventricular ejection fraction (LVEF), LV mass (LVM), end-diastolic volume (EDV), end-systolic volume (ESV), LV atrioventricular plane displacement (LVAPD), and circumferential uniformity ratio estimate (CURE). LVM, EDV, and ESV were normalized to body surface area for a normalized index of LVM (LVMI), EDV (EDVI) and ESV (ESVI). RESULTS At baseline, LV ℇcc% was significantly worse in DMD compared to controls and five of the six mid LV segments demonstrated abnormal strain in DMD. Longitudinal measurements revealed that ℇcc% consistently declined in individuals with DMD with the inferior segments being more affected. LVEF progressively declined between 3 to 5 years post baseline visit. In a multivariate analysis, the use of cardioprotective drugs trended towards positively impacting cardiac measures while loss of ambulation and baseline age were associated with negative impact. Eight out of 17 cardiac parameters reached a minimal clinically important difference with a threshold of 1/3 standard deviation. CONCLUSION The study shows a worsening of circumferential strain in dystrophic myocardium. The findings emphasize the significance of early and longitudinal assessment of cardiac function in DMD and identify early biomarkers of cardiac dysfunction to help design clinical trials to mitigate cardiac pathology. This study provides valuable non-invasive and non-contrast based natural history data of cardiac changes which can be used to design clinical trials or interpret the results of current trials aimed at mitigating the effects of decreased cardiac function in DMD.
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Affiliation(s)
- Abhinandan Batra
- Department of Physical Therapy, University of Florida, Gainesville, FL, 32610, USA
| | - Alison M Barnard
- Department of Physical Therapy, University of Florida, Gainesville, FL, 32610, USA
| | - Donovan J Lott
- Department of Physical Therapy, University of Florida, Gainesville, FL, 32610, USA
| | - Rebecca J Willcocks
- Department of Physical Therapy, University of Florida, Gainesville, FL, 32610, USA
| | - Sean C Forbes
- Department of Physical Therapy, University of Florida, Gainesville, FL, 32610, USA
| | | | - Michael J Daniels
- Department of Statistics, University of Florida, Gainesville, FL, 32610, USA
| | - Jannik Arbogast
- Department of Physiology and Functional Genomics, University of Florida, 1600 SW Archer RD, M552, P.O. Box 1002754, Gainesville, FL, 32610, USA
| | - William Triplett
- Department of Physical Therapy, University of Florida, Gainesville, FL, 32610, USA
| | - Erik K Henricson
- Department of Physical Medicine and Rehabilitation, University of California, Davis, Sacramento, CA, 95817, USA
| | | | - Carsten Schmalfuss
- Department of Medicine, Cardiology, University of Florida, Gainesville, FL, 32610, USA
| | - Lee Sweeney
- Department of Pharmacology and Therapeutics, University of Florida, Gainesville, FL, 32610, USA
| | - Barry J Byrne
- Department of Pediatrics, University of Florida, Gainesville, FL, 32610, USA
| | - Craig M McDonald
- Department of Physical Medicine and Rehabilitation, University of California, Davis, Sacramento, CA, 95817, USA
| | - Krista Vandenborne
- Department of Physical Therapy, University of Florida, Gainesville, FL, 32610, USA
| | - Glenn A Walter
- Department of Physiology and Functional Genomics, University of Florida, 1600 SW Archer RD, M552, P.O. Box 1002754, Gainesville, FL, 32610, USA.
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