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The Editor,  Sir,  Hypertrophic cardiomyopathy (HCM) is a genetic and familial cardiovascular disease which can cause severe arrhythmia and heart failure. With irregular hypertrophy and disorganized arrangement of cardiomyocytes on histological picture, the normal myocardium macrostructure appears in whole or part as ventricular wall thickness, especially ventricular septal thickness (1).  The variation of myocardial microstructures is associated with a range of clinical outcomes. However, common examinations such as echocardiography and delayed enhancement magnetic resonance (DE-MR) can only diagnose HCM after cardiac dysfunction and macro structural changes. Although histology is the gold standard for HCM, it is unable to quantify changes and display 3D spatial structure. Therefore, highly sensitive and ultra-early examination techniques are in urgent need for the diagnosis of HCM.  Based on anisotropy of water molecules movement in different tissues, diffusion tensor imaging (DTI) can be used to quantify the diffusion characterization of internal water molecules in tissues (2). In the clinical setting, DTI is widely used in tractography of the central nervous system.  Intrinsically, DTI is a multi-parametric method to quantify myocardial fibres by means of multiple aspects, such as orientations using primary eigenvector, mechanical function using helix angle (HA) and transmural angle (TA), diffusion characteristic using fractional anisotropy (FA) and apparent diffusion coefficient (ADC).  Recently, DTI has been applied to trace myocardial fibre of animal heart in vitro. Healy et al found that the range of helix angle and transmural angle through the left ventricle was significantly different among species (3). Their results proved the sensitivity of DTI to explore variation of microstructures in myocardial fibres and laid the foundation for further studies.  Despite great challenges of DTI for in vivo heart due to cardiac motion, Toussaint et al successfully reconstructed the architecture of myocardial fibre in healthy volunteers in vivo (4). Wei et al also developed a multi-modal approach to assess the effects of cardiac motion on the human heart by diffusion tensor parameters. Their research is impressive and encouraging for improving imaging methods and evaluating myocardial fibres in vivo (5).  We propose that DTI is a sensitive method to diagnose the micro alternations of myocardial fibre in hypertrophic cardiomyopathy before occurrence of severe clinical symptoms or cardiac dysfunction in non-invasive and quantitative measurement. Three-dimension myocardial fibre architecture and corresponding quantitative parameters of patients will be revealed by DTI for in vivo heart in the very near future. This technique enables dynamic observation of patients and longterm follow-up to detect lesions promptly. Combining mechanical method with molecular imaging, DTI has excellent ability to solve clinical problems and achieve translational medicine.  Diffusion tensor imaging, an essential examination method, will have extensive application in clinical diagnosis to benefit more patients with HCM in future.

The Significance of Evaluating the Variation of Mechanical Microstructure for Hypertrophic Cardiomyopathy Using Diffusion Tensor Magnetic