{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T15:44:32Z","timestamp":1789055072328,"version":"build-2803163510"},"reference-count":23,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T00:00:00Z","timestamp":1738195200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIH","award":["R01 HL131975"],"award-info":[{"award-number":["R01 HL131975"]}]},{"name":"NIH","award":["DGE 1650604"],"award-info":[{"award-number":["DGE 1650604"]}]},{"name":"NSF","award":["R01 HL131975"],"award-info":[{"award-number":["R01 HL131975"]}]},{"name":"NSF","award":["DGE 1650604"],"award-info":[{"award-number":["DGE 1650604"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Duchenne Muscular Dystrophy (DMD) is a prevalent fatal genetic disorder, and heart failure is the leading cause of mortality. Peak left ventricular (LV) circumferential strain (Ecc), twist, and circumferential-longitudinal shear angle (\u03b8CL) are promising biomarkers for the improved and early diagnosis of incipient heart failure. Our goals were as follows: 1) to characterize a spectrum of functional and rotational LV biomarkers in boys with DMD compared with healthy age-matched controls; and 2) to identify LV biomarkers of early cardiomyopathy in the absence of abnormal LVEF or LGE. Methods: Boys with DMD (N = 43) and age-matched healthy volunteers (N = 16) were prospectively enrolled and underwent a 3T CMR exam after obtaining informed consent. Breath-held MRI tagging was used to estimate left ventricular Ecc at the mid-ventricular level as well as the twist, torsion, and \u03b8CL between basal and apical LV short-axis slices. A two-tailed t-test with unequal variance was used to test group-wise differences. Multiple comparisons were performed with Holm\u2013Sidak post hoc correction. Multiple-regression analysis was used to test for correlations among biomarkers. A binomial logistic regression model assessed each biomarker\u2019s ability to distinguish the following: (1) healthy volunteers vs. DMD patients, (2) healthy volunteers vs. LGE(\u2212) DMD patients, and (3) LGE(\u2212) DMD patients vs. LGE(+) DMD patients. Results: There was a significant impairment in the peak mid-wall Ecc [\u221217.0 \u00b1 4.2% vs. \u221219.5 \u00b1 1.9%, p &lt; 7.8 \u00d7 10\u22123], peak LV twist (10.4 \u00b1 4.3\u00b0 vs. 15.6 \u00b1 3.1\u00b0, p &lt; 8.1 \u00d7 10\u22124), and peak LV torsion (2.03 \u00b1 0.82\u00b0\/mm vs. 2.8 \u00b1 0.5\u00b0\/mm, p &lt; 2.6 \u00d7 10\u22123) of LGE(\u2212) DMD patients when compared to healthy volunteers. There was a further significant reduction in the Ecc, twist, torsion, and \u03b8CL for LGE(+) DMD patients when compared to LGE(\u2212) DMD patients. In the LGE(+) DMD patients, age significantly correlated with LVEF (r2 = 0.42, p = 9 \u00d7 10\u22123), peak mid-wall Ecc (r2 = 0.27, p = 0.046), peak LV Twist (r2 = 0.24, p = 0.06), peak LV torsion (r2 = 0.28, p = 0.04), and peak LV \u03b8CL (r2 = 0.23, p = 0.07). In the LGE(\u2212) DMD patients, only the peak mid-wall Ecc was significantly correlated with age (r2 = 0.25, p = 0.006). The peak LV twist outperformed the peak mid-wall LV Ecc and EF in distinguishing DMD patients from healthy volunteer groups (AUC = 0.88, 0.80, and 0.72), as well as in distinguishing LGE(\u2212) DMD patients from healthy volunteers (AUC = 0.83, 0.74, and 0.62). The peak LV twist and peak mid-wall LV Ecc performed similarly in distinguishing the LGE(\u2212) and LGE(+) DMD cohorts (AUC = 0.74, 0.77, and 0.79). Conclusions: The peak mid-wall LV Ecc, peak LV twist, peak LV torsion, and peak LV \u03b8CL were significantly impaired in advance of the decreased LVEF and the development of focal myocardial fibrosis in boys with DMD and therefore were apparent prior to significant irreversible injury.<\/jats:p>","DOI":"10.3390\/diagnostics15030326","type":"journal-article","created":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T11:08:23Z","timestamp":1738235303000},"page":"326","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Left Ventricular Twist and Circumferential Strain from MRI Tagging Predict Early Cardiovascular Disease in Duchenne Muscular Dystrophy"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6873-9501","authenticated-orcid":false,"given":"Zhan-Qiu","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Radiology, Stanford University, Palo Alto, CA 94305, USA"},{"name":"Cardiovascular Institute, Stanford University, Palo Alto, CA 94305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Magrath","sequence":"additional","affiliation":[{"name":"Department of Bioengineering, University of California, Los Angeles, CA 90095, USA"},{"name":"Department of Radiological Sciences, University of California, Los Angeles, CA 90095, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nyasha G.","family":"Maforo","sequence":"additional","affiliation":[{"name":"Department of Radiological Sciences, University of California, Los Angeles, CA 90095, USA"},{"name":"Physics and Biology in Medicine Interdepartmental Program, University of California, Los Angeles, CA 90095, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Loecher","sequence":"additional","affiliation":[{"name":"Department of Radiology, Stanford University, Palo Alto, CA 94305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2585-5916","authenticated-orcid":false,"given":"Holden H.","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Bioengineering, University of California, Los Angeles, CA 90095, USA"},{"name":"Department of Radiological Sciences, University of California, Los Angeles, CA 90095, USA"},{"name":"Physics and Biology in Medicine Interdepartmental Program, University of California, Los Angeles, CA 90095, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8615-5246","authenticated-orcid":false,"given":"Ashley","family":"Prosper","sequence":"additional","affiliation":[{"name":"Department of Radiological Sciences, University of California, Los Angeles, CA 90095, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierangelo","family":"Renella","sequence":"additional","affiliation":[{"name":"Department of Radiological Sciences, University of California, Los Angeles, CA 90095, USA"},{"name":"Department of Medicine, Division of Pediatric Cardiology, CHOC Children\u2019s Hospital, Orange, CA 92868, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Halnon","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of California, Los Angeles, CA 90095, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel B.","family":"Ennis","sequence":"additional","affiliation":[{"name":"Department of Radiology, Stanford University, Palo Alto, CA 94305, USA"},{"name":"Cardiovascular Institute, Stanford University, Palo Alto, CA 94305, USA"},{"name":"Maternal & Child Health Research Institute, Stanford University, Palo Alto, CA 94305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1590","DOI":"10.1161\/CIRCULATIONAHA.114.015151","article-title":"Contemporary cardiac issues in Duchenne muscular dystrophy","volume":"131","author":"McNally","year":"2015","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1002\/mrm.25387","article-title":"Free-breathing multislice native myocardial T1 mapping using the slice-interleaved T1 (STONE) sequence","volume":"74","author":"Roujol","year":"2015","journal-title":"Magn. 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