{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T17:01:27Z","timestamp":1791910887601,"version":"4.3.4"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2021,10,25]],"date-time":"2021-10-25T00:00:00Z","timestamp":1635120000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000327","name":"Heart Research UK","doi-asserted-by":"publisher","award":["RG2668\/18\/20"],"award-info":[{"award-number":["RG2668\/18\/20"]}],"id":[{"id":"10.13039\/501100000327","id-type":"DOI","asserted-by":"publisher"}]},{"name":"British Heart Foundation Chair","award":["CH\/16\/2\/32089"],"award-info":[{"award-number":["CH\/16\/2\/32089"]}]},{"name":"Medical Research Council UK Clinical Academic Partnership","award":["MR\/T005181\/1"],"award-info":[{"award-number":["MR\/T005181\/1"]}]},{"name":"British Heart Foundation Intermediate Clinical Research Fellowship","award":["FS\/13\/71\/30378"],"award-info":[{"award-number":["FS\/13\/71\/30378"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,2,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Microvascular dysfunction in hypertrophic cardiomyopathy (HCM) is predictive of clinical decline, however underlying mechanisms remain unclear. Cardiac diffusion tensor imaging (cDTI) allows in vivo characterization of myocardial microstructure by quantifying mean diffusivity (MD), fractional anisotropy (FA) of diffusion, and secondary eigenvector angle (E2A). In this cardiac magnetic resonance (CMR) study, we examine associations between perfusion and cDTI parameters to understand the sequence of pathophysiology and the interrelation between vascular function and underlying microstructure.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>Twenty HCM patients underwent 3.0T CMR which included: spin-echo cDTI, adenosine stress and rest perfusion mapping, cine-imaging, and late gadolinium enhancement (LGE). Ten controls underwent cDTI. Myocardial perfusion reserve (MPR), MD, FA, E2A, and wall thickness were calculated per segment and further divided into subendocardial (inner 50%) and subepicardial (outer 50%) regions. Segments with wall thickness \u226411\u2009mm, MPR \u22652.2, and no visual LGE were classified as \u2018normal\u2019. Compared to controls, \u2018normal\u2019 HCM segments had increased MD (1.61\u2009\u00b1\u20090.09 vs. 1.46\u2009\u00b1\u20090.07\u2009\u00d7\u200910\u22123\u2009mm2\/s, P\u2009=\u20090.02), increased E2A (60\u2009\u00b1\u20099\u00b0 vs. 38\u2009\u00b1\u200912\u00b0, P\u2009&amp;lt;\u20090.001), and decreased FA (0.29\u2009\u00b1\u20090.04 vs. 0.35\u2009\u00b1\u20090.02, P\u2009=\u20090.002). Across all HCM segments, subendocardial regions had higher MD and lower MPR than subepicardial (MDendo 1.61\u2009\u00b1\u20090.08\u2009\u00d7\u200910\u22123\u2009mm2\/s vs. MDepi 1.56\u2009\u00b1\u20090.18\u2009\u00d7\u200910\u22123\u2009mm2\/s, P\u2009=\u20090.003, MPRendo 1.85\u2009\u00b1\u20090.83, MPRepi 2.28\u2009\u00b1\u20090.87, P\u2009&amp;lt;\u20090.0001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>In HCM patients, even in segments with normal wall thickness, normal perfusion, and no scar, diffusion is more isotropic than in controls, suggesting the presence of underlying cardiomyocyte disarray. Increased E2A suggests the myocardial sheetlets adopt hypercontracted angulation in systole. Increased MD, most notably in the subendocardium, is suggestive of regional remodelling which may explain the reduced subendocardial blood flow.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjci\/jeab210","type":"journal-article","created":{"date-parts":[[2021,10,17]],"date-time":"2021-10-17T11:05:56Z","timestamp":1634468756000},"page":"352-362","source":"Crossref","is-referenced-by-count":54,"title":["Phenotyping hypertrophic cardiomyopathy using cardiac diffusion magnetic resonance imaging: the relationship between microvascular dysfunction and microstructural changes"],"prefix":"10.1093","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1134-3036","authenticated-orcid":false,"given":"Arka","family":"Das","sequence":"first","affiliation":[{"name":"Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds LS2 9JT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Kelly","sequence":"additional","affiliation":[{"name":"Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds LS2 9JT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irvin","family":"Teh","sequence":"additional","affiliation":[{"name":"Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds LS2 9JT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, 55 Fruit St, Boston, MA 02114, USA"},{"name":"A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, 55 Fruit St, Boston, MA 02114, USA"},{"name":"Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA"},{"name":"Biomedical Imaging Research Institute, Cedars-Sinai Medical Centre, 116 N Robertson Blvd, Los Angeles, CA 90048, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise A E","family":"Brown","sequence":"additional","affiliation":[{"name":"Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds LS2 9JT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2073-4138","authenticated-orcid":false,"given":"Amrit","family":"Chowdhary","sequence":"additional","affiliation":[{"name":"Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds LS2 9JT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9395-584X","authenticated-orcid":false,"given":"Nicholas","family":"Jex","sequence":"additional","affiliation":[{"name":"Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds LS2 9JT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharmaine","family":"Thirunavukarasu","sequence":"additional","affiliation":[{"name":"Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds LS2 9JT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5880-1722","authenticated-orcid":false,"given":"Noor","family":"Sharrack","sequence":"additional","affiliation":[{"name":"Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds LS2 9JT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miroslawa","family":"Gorecka","sequence":"additional","affiliation":[{"name":"Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds LS2 9JT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter P","family":"Swoboda","sequence":"additional","affiliation":[{"name":"Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds LS2 9JT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John P","family":"Greenwood","sequence":"additional","affiliation":[{"name":"Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds LS2 9JT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9875-6070","authenticated-orcid":false,"given":"Peter","family":"Kellman","sequence":"additional","affiliation":[{"name":"National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, 31 Center Dr, Bethesda, MD 20892, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James C","family":"Moon","sequence":"additional","affiliation":[{"name":"Barts Heart Centre, The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, St Bartholomew\u2019s Hospital, West Smithfield, London EC1A 7BE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhodri H","family":"Davies","sequence":"additional","affiliation":[{"name":"Barts Heart Centre, The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, St Bartholomew\u2019s Hospital, West Smithfield, London EC1A 7BE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis R","family":"Lopes","sequence":"additional","affiliation":[{"name":"Barts Heart Centre, The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, St Bartholomew\u2019s Hospital, West Smithfield, London EC1A 7BE, UK"},{"name":"Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1467-5490","authenticated-orcid":false,"given":"George","family":"Joy","sequence":"additional","affiliation":[{"name":"Barts Heart Centre, The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, St Bartholomew\u2019s Hospital, West Smithfield, London EC1A 7BE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven","family":"Plein","sequence":"additional","affiliation":[{"name":"Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds LS2 9JT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen E","family":"Schneider","sequence":"additional","affiliation":[{"name":"Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds LS2 9JT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica","family":"Dall\u2019Armellina","sequence":"additional","affiliation":[{"name":"Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds LS2 9JT, 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cardiomyopathy","volume":"48","author":"Wu","year":"2018","journal-title":"J Magn Reson Imaging"},{"key":"2022022217015211300_jeab210-B10","doi-asserted-by":"crossref","first-page":"2493","DOI":"10.1016\/j.jacc.2019.02.065","article-title":"Identification of myocardial disarray in patients with hypertrophic cardiomyopathy and ventricular arrhythmias","volume":"73","author":"Ariga","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"2022022217015211300_jeab210-B11","doi-asserted-by":"crossref","first-page":"1378","DOI":"10.1002\/nbm.3200","article-title":"Characterization of diffuse fibrosis in the failing human heart via diffusion tensor imaging and quantitative histological validation NIH public access","volume":"27","author":"Abdullah","year":"2014","journal-title":"NMR Biomed"},{"key":"2022022217015211300_jeab210-B12","doi-asserted-by":"crossref","first-page":"30573","DOI":"10.1038\/srep30573","article-title":"Resolving fine cardiac structures in rats with high-resolution 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cardiomyopathy","volume":"72","author":"Elliott","year":"2015","journal-title":"Russ J Cardiol"},{"key":"2022022217015211300_jeab210-B16","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s12968-017-0355-5","article-title":"Myocardial perfusion cardiovascular magnetic resonance: optimized dual sequence and reconstruction for quantification","volume":"19","author":"Kellman","year":"2017","journal-title":"J Cardiovasc Magn Reson"},{"key":"2022022217015211300_jeab210-B17","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1186\/1532-429X-15-91","article-title":"Standardized cardiovascular magnetic resonance (CMR) protocols 2013 update","volume":"15","author":"Kramer","year":"2013","journal-title":"J Cardiovasc Magn Reson"},{"key":"2022022217015211300_jeab210-B18","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1002\/mrm.25038","article-title":"In vivo three-dimensional high resolution cardiac diffusion-weighted MRI: a motion compensated diffusion-prepared 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