51
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Trivedi SJ, Altman M, Stanton T, Thomas L. Echocardiographic Strain in Clinical Practice. Heart Lung Circ 2019; 28:1320-1330. [DOI: 10.1016/j.hlc.2019.03.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/17/2019] [Accepted: 03/22/2019] [Indexed: 01/07/2023]
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52
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Iwashima S, Hayano S, Murakami Y, Tanaka A, Joko Y, Morikawa S, Ifuku M, Iso T, Takahashi K. Cardiac Function in Infants Born to Mothers With Gestational Diabetes - Estimation of Early Diastolic Intraventricular Pressure Differences. Circ Rep 2019; 1:378-388. [PMID: 33693166 PMCID: PMC7892812 DOI: 10.1253/circrep.cr-19-0062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background:
This study compared the myocardial performance of infants born to mothers with gestational diabetes mellitus (IGDM) and without GDM (controls) under the new GDM definitions. Methods and Results:
The subjects consisted of 36 IGDM and 39 control infants. GDM diagnosis was based on oral glucose tolerance test during pregnancy or the presence of diabetes prior to the current pregnancy. Between-group infant cardiac function was determined and compared using 2-D speckle tracking analysis, intraventricular pressure difference (IVPD) and IVP gradient (IVPG), using color M-mode Doppler imaging. IVPD and IVPG were higher in IGDM than in the controls, particularly the mid–apical IVPG. The global circumferential strain (GCS) and endocardial GCS were higher in IGDM than in controls. Increased maternal glycated hemoglobin was correlated with reduced transmural and epicardial GCS in the IGDM. Maternal maximum fasting blood sugar had a mild, positive correlation with IVPD and IVPG. Conclusions:
Ventricular sucking force, measured as the IVPD, IVPG, and endocardial GCS, were higher in IGDM than in the controls. A hyperglycemic environment during pregnancy leads to impaired cardiac performance in IGDM, compared with control infants. IGDM might have favorable systolic and diastolic cardiac performance due to cardiac metabolic adaptations occurring before poor glucose control causes impaired cardiac performance.
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Affiliation(s)
- Satoru Iwashima
- Department of Pediatric Cardiology, Chutoen General Medical Center Kakegawa Japan
| | - Satoshi Hayano
- Department of Pediatric Cardiology, Chutoen General Medical Center Kakegawa Japan
| | - Yusuke Murakami
- Department of Obstetrics and Gynecology, Chutoen General Medical Center Kakegawa Japan
| | - Aki Tanaka
- Department of Obstetrics and Gynecology, Chutoen General Medical Center Kakegawa Japan
| | - Yumiko Joko
- Department of Cardiology, Chutoen General Medical Center Kakegawa Japan
| | - Shuji Morikawa
- Department of Cardiology, Chutoen General Medical Center Kakegawa Japan
| | - Mayumi Ifuku
- Department of Pediatrics, Juntendo University Faculty of Medicine Tokyo Japan
| | - Takeshi Iso
- Department of Pediatrics, Juntendo University Faculty of Medicine Tokyo Japan
| | - Ken Takahashi
- Department of Pediatrics, Juntendo University Faculty of Medicine Tokyo Japan
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53
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Neisius U, Myerson L, Fahmy AS, Nakamori S, El-Rewaidy H, Joshi G, Duan C, Manning WJ, Nezafat R. Cardiovascular magnetic resonance feature tracking strain analysis for discrimination between hypertensive heart disease and hypertrophic cardiomyopathy. PLoS One 2019; 14:e0221061. [PMID: 31433823 PMCID: PMC6703851 DOI: 10.1371/journal.pone.0221061] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/29/2019] [Indexed: 01/19/2023] Open
Abstract
Background Hypertensive heart disease (HHD) and hypertrophic cardiomyopathy (HCM) are both associated with an increased left ventricular (LV) wall thickness. Whilst LV ejection fraction is frequently normal in both, LV strain assessment could differentiate between the diseases. We sought to establish if cardiovascular magnetic resonance myocardial feature tracking (CMR-FT), an emerging method allowing accurate assessment of myocardial deformation, differentiates between both diseases. Additionally, CMR assessment of fibrosis and LV hypertrophy allowed association analyses and comparison of diagnostic capacities. Methods Two-hundred twenty-four consecutive subjects (53 HHD, 107 HCM, and 64 controls) underwent 1.5T CMR including native myocardial T1 mapping and late gadolinium enhancement (LGE). Global longitudinal strain (GLS) was assessed by CMR-FT (CVi42, Circle Cardiovascular Imaging Inc.). Results GLS was significantly higher in HCM patients (-14.7±3.8 vs. -16.5±3.3% [HHD], P = 0.004; or vs. -17.2±2.0% [controls], P<0.001). GLS was associated with LV mass index (HHD, R = 0.419, P = 0.002; HCM, R = 0.429, P<0.001), and LV ejection fraction (HHD, R = -0.493, P = 0.002; HCM, R = -0.329, P<0.001). In HCM patients, GLS was also associated with global native T1 (R = 0.282, P = 0.003), and LGE volume (ρ = 0.380, P<0.001). Discrimination between HHD and HCM by GLS (c = 0.639, 95% confidence interval [CI] 0.550–0.729) was similar to LV mass index (c = 0.643, 95% CI 0.556–0.731), global myocardial native T1 (c = 0.718, 95% CI 0.638–0.799), and LGE volume (c = 0.680, 95% CI 0.585–0.775). Conclusion CMR-FT GLS differentiates between HHD and HCM. In HCM patients GLS is associated with myocardial fibrosis. The discriminatory capacity of CMR-FT GLS is similar to LV hypertrophy and fibrosis imaging markers.
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Affiliation(s)
- Ulf Neisius
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America
| | - Lana Myerson
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America
| | - Ahmed S. Fahmy
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America
| | - Shiro Nakamori
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America
| | - Hossam El-Rewaidy
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America
| | - Gargi Joshi
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America
| | - Chong Duan
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America
| | - Warren J. Manning
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America
- Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America
| | - Reza Nezafat
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America
- * E-mail:
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54
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Delgado V, Ajmone Marsan N. Global and Regional Longitudinal Strain Assessment in Hypertrophic Cardiomyopathy. Circ Cardiovasc Imaging 2019; 12:e009586. [PMID: 31412721 DOI: 10.1161/circimaging.119.009586] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Victoria Delgado
- Department of Cardiology, Leiden University Medical Center; the Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center; the Netherlands
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55
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Barberato SH, Romano MMD, Beck ALDS, Rodrigues ACT, Almeida ALCD, Assunção BMBL, Gripp EDA, Guimarães Filho FV, Abensur H, Castillo JMD, Miglioranza MH, Vieira MLC, Barros MVLD, Nunes MDCP, Otto MEB, Hortegal RDA, Barretto RBDM, Campos TH, Siqueira VND, Morhy SS. Position Statement on Indications of Echocardiography in Adults - 2019. Arq Bras Cardiol 2019; 113:135-181. [PMID: 31411301 PMCID: PMC6684182 DOI: 10.5935/abc.20190129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Silvio Henrique Barberato
- CardioEco-Centro de Diagnóstico Cardiovascular, Curitiba, PR - Brazil.,Quanta Diagnóstico e Terapia, Curitiba, PR - Brazil
| | - Minna Moreira Dias Romano
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP - Brazil
| | - Adenalva Lima de Souza Beck
- Instituto de Cardiologia do Distrito Federal, Brasília, DF - Brazil.,Fundação Universitária de Cardiologia (ICDF/FUC), Brasília, DF - Brazil
| | - Ana Clara Tude Rodrigues
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP - Brazil
| | | | | | - Eliza de Almeida Gripp
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brazil.,Hospital Universitário Antônio Pedro, Niterói, RJ - Brazil.,DASA, São Paulo, SP - Brazil
| | | | - Henry Abensur
- Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP - Brazil
| | | | - Marcelo Haertel Miglioranza
- Fundação Universitária de Cardiologia (ICDF/FUC), Brasília, DF - Brazil.,Instituto de Cardiologia de Porto Alegre, Porto Alegre, RS - Brazil
| | - Marcelo Luiz Campos Vieira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP - Brazil.,Hospital Israelita Albert Einstein, São Paulo, SP - Brazil
| | - Márcio Vinicius Lins de Barros
- Faculdade de Saúde e Ecologia Humana (FASEH), Vespasiano, MG - Brazil.,Rede Materdei de Saúde, Belo Horizonte, MG - Brazil.,Hospital Vera Cruz, Belo Horizonte, MG - Brazil
| | | | | | | | | | - Thais Harada Campos
- Diagnoson-Fleury, Salvador, BA - Brazil.,Hospital Ana Nery, Salvador, BA - Brazil
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56
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Cao Y, Sun XY, Zhong M, Li L, Zhang M, Lin MJ, Zhang YK, Jiang GH, Zhang W, Shang YY. Evaluation of hemodynamics in patients with hypertrophic cardiomyopathy by vector flow mapping: Comparison with healthy subjects. Exp Ther Med 2019; 17:4379-4388. [PMID: 31105778 PMCID: PMC6507509 DOI: 10.3892/etm.2019.7507] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 02/27/2019] [Indexed: 12/13/2022] Open
Abstract
The present study investigated the role of energy loss assessed by vector flow mapping (VFM) in patients with hypertrophic cardiomyopathy (HCM). VFM analysis was performed in 42 patients with HCM and in 40 control subjects, which were matched for age, sex and left ventricular (LV) ejection fraction. The intra-LV and left atrial blood flow were obtained from the apical 3-chamber view, and the energy loss (EL) during the systolic and diastolic phases was calculated. The measurements were averaged over three cardiac cycles and indexed to body surface area. Compared with the controls, the left ventricular energy loss (LVEL)-total value was significantly decreased in patients with HCM during the diastolic phase (P1, P2 and P3; all P<0.05). A tendency for increased systolic LVEL-total values was observed in the patients with HCM compared with the controls (P>0.05). LVEL-base values were decreased in the patients with HCM during P1 and P2 (slow filling time). Compared with the controls, patients with HCM had lower LVEL-mid values during the diastolic phases (P0, P1, P2 and P3; all P<0.05). However, the LVEL-mid value of patients with HCM was higher compared with that of the controls during systolic P5 (P<0.05). LVEL-apex was decreased in patients with HCM during P0, P2 and P3. Compared with the controls, the left atrial energy loss (LAEL) of all three phases in patients with HCM were lower (each P<0.01). The diastolic LVEL values were significantly lower in patients with HCM compared with the controls; however, the systolic LVEL levels tended to be higher in HCM. The LAEL of the reservoir phase, conduit phase and atrial systolic phase were decreased in HCM compared with controls. The present study demonstrated that measurement of EL by VFM is a sensitive method of determining subclinical LV dysfunction in patients with HCM. The value of EL has been considered to be a quantitative parameter for the estimation of the efficiency of intraventricular blood flow.
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Affiliation(s)
- Yuan Cao
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Xiao-Yan Sun
- Department of Cardiology, Heze Municipal Hospital, Heze, Shandong 274000, P.R. China
| | - Ming Zhong
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Li Li
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Mei Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Ming-Jie Lin
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Yu-Ke Zhang
- Department of Intensive Care Medicine, Qianfoshan Hospital of Shandong Province, Jinan, Shandong 250014, P.R. China
| | - Gui-Hua Jiang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Wei Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Yuan-Yuan Shang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
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57
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Satriano A, Heydari B, Guron N, Fenwick K, Cheung M, Mikami Y, Merchant N, Lydell CP, Howarth AG, Fine NM, White JA. 3-Dimensional regional and global strain abnormalities in hypertrophic cardiomyopathy. Int J Cardiovasc Imaging 2019; 35:1913-1924. [PMID: 31144257 DOI: 10.1007/s10554-019-01631-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 05/18/2019] [Indexed: 12/28/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is characterized by myocardial disarray, hypertrophy, and fibrosis. Reduced global longitudinal strain and presence of late gadolinium enhancement (LGE) by cardiac magnetic resonance imaging (CMR) have been associated with an adverse prognosis. This study evaluated 3D principal and conventional strain characteristics of non-enhanced myocardium in patients with HCM. 3D principal and conventional strain analysis was conducted in 51 HCM patients and 38 healthy controls. Principal strain was reduced within the non-enhanced myocardium of HCM as compared with controls (maximum principal: 51.5 ± 23.7 vs. 75.1 ± 21.4%, P < 0.0001; minimum principal: - 18.4 ± 4.0 vs. - 20.1 ± 2.9%, P < 0.05). Principal strain within the non-enhanced myocardium was incrementally reduced in HCM patients with extensive global LGE ( ≥ 15%) (maximum principal: 41.6 ± 17.5 vs. 56.9 ± 25.9%, P < 0.05; minimum principal: - 16.9 ± 3.9 vs. - 19.1 ± 4.0%, P = 0.1), as was longitudinal ( - 10.5 ± 2.6 vs. - 12.7 ± 2.6%, P < 0.05) and circumferential strain ( - 11.0 ± 2.7 vs. - 14.0 ± 2.9%, P < 0.01). Principal strain within non-enhanced myocardium was significantly correlated with indexed LV mass (P < 0.0001), maximum (P = 0.0008), and mean wall thickness (P < 0.0001), but not LGE (P = 0.0841). In adjusted analysis, all strain measures within non-enhanced myocardium were independently associated with indexed LV mass (maximum principal: P = 0.0003; minimum principal: P = 0.0039; longitudinal: P = 0.0015; circumferential: P = 0.0002; radial: P = 0.0023). 3D principal strain of non-enhanced myocardium was significantly reduced in HCM patients as compared with controls, and was incrementally reduced among patients with more extensive global LGE. Comprehensive strain assessment may be considered in routine CMR assessment of HCM patients.
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Affiliation(s)
- Alessandro Satriano
- Division of Cardiology, Department of Cardiac Sciences, Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Canada
| | - Bobak Heydari
- Division of Cardiology, Department of Cardiac Sciences, Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Canada. .,Foothills Medical Centre, Suite 0700, 1403 29th St NW, Calgary, AB, T2N 2T9, Canada.
| | - Namrata Guron
- Division of Cardiology, Department of Cardiac Sciences, Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Canada
| | - Kate Fenwick
- Division of Cardiology, Department of Cardiac Sciences, Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Canada
| | - Matthew Cheung
- Division of Cardiology, Department of Cardiac Sciences, Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Canada
| | - Yoko Mikami
- Division of Cardiology, Department of Cardiac Sciences, Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Canada
| | - Naeem Merchant
- Division of Cardiology, Department of Cardiac Sciences, Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Canada.,Department of Diagnostic Imaging, University of Calgary, Calgary, Canada
| | - Carmen P Lydell
- Division of Cardiology, Department of Cardiac Sciences, Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Canada.,Department of Diagnostic Imaging, University of Calgary, Calgary, Canada
| | - Andrew G Howarth
- Division of Cardiology, Department of Cardiac Sciences, Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Canada
| | - Nowell M Fine
- Division of Cardiology, Department of Cardiac Sciences, Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Canada
| | - James A White
- Division of Cardiology, Department of Cardiac Sciences, Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Canada
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58
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Baron T, Christersson C, Hjorthén G, Hedin EM, Flachskampf FA. Changes in global longitudinal strain and left ventricular ejection fraction during the first year after myocardial infarction: results from a large consecutive cohort. Eur Heart J Cardiovasc Imaging 2019; 19:1165-1173. [PMID: 29145641 DOI: 10.1093/ehjci/jex260] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 10/24/2017] [Indexed: 02/03/2023] Open
Abstract
Aims To determine changes of global longitudinal strain (GLS) and their predictors in relation to classical echocardiographic parameters of left ventricular (LV) function, over 1 year, in consecutive patients with myocardial infarction (MI) and initially normal or impaired LV ejection fraction (EF). Methods and results A total of 285 patients with MI prospectively included in the REBUS (RElevance of Biomarkers for future risk of thromb-oembolic events in UnSelected post-myocardial infarction patients) study underwent echocardiography within 72 h from admission and after 1 year. At baseline, 213 (74.7%) of MI patients had a normal EF (≥52% in men or ≥54% in women), but in 70.4% of them, an impaired GLS ( ≥ -18.0%) was observed. During 1-year follow-up, in patients with normal EF at baseline, GLS improved from -15.8% to - 17.4% (10.1% relative change); EF decreased from 62.5% to 59.9% (4.0% relative change); indexed end-diastolic volume, indexed end-systolic volume, and indexed stroke volume increased with 15.6%, 24.8%, and 10.0% of relative change, respectively (P < 0.001 for all the comparisons). In the whole cohort, initial impairment of LV function [by EF, wall motion score index (WMSI), or GLS], male gender, non-smoking, and treatment with beta-blockers were the independent predictors of GLS improvement. In the group with initially impaired EF, over 1 year GLS improved from -11.9% to - 14.8% (24.4% relative change) and EF from 44.6% to 52.6% (18.2% relative change) (P < 0.001 for both). Improvement in GLS significantly correlated with EF increase in the group with impaired EF (r = -0.41, P = 0.001) but not in the patients with normal EF (r = -0.14, P = ns). Conclusions Despite diveregent evolution of GLS compared with EF and ventricular volumes, one year after MI GLS significantly improved in patients with initially both normal and impaired EF. Initial impairment of LV function (by EF, WMSI, or GLS), male gender, non-smoking, and treatment with beta-blockers were independent predictors of GLS improvement. LV remodelling was present even in patients with normal EF at baseline and during follow-up, confirming limited functional assessment by EF alone.
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Affiliation(s)
- Tomasz Baron
- Division of Cardiology, Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Christina Christersson
- Division of Cardiology, Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | | | - Eva-Maria Hedin
- Division of Cardiology, Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Frank A Flachskampf
- Division of Cardiology, Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
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59
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Spalla I, Boswood A, Connolly DJ, Luis Fuentes V. Speckle tracking echocardiography in cats with preclinical hypertrophic cardiomyopathy. J Vet Intern Med 2019; 33:1232-1241. [PMID: 30993757 PMCID: PMC6524080 DOI: 10.1111/jvim.15495] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 03/27/2019] [Indexed: 12/20/2022] Open
Abstract
Background Cats with hypertrophic cardiomyopathy (HCM) have decreased left ventricular (LV) longitudinal deformation detected by mitral annular plane systolic excursion (MAPSE) and speckle tracking echocardiography. People with preclinical HCM have decreased systolic LV longitudinal and radial strain (S) and strain rate (SR), with preserved circumferential S and SR. Hypothesis/Objectives Cats with preclinical HCM have decreased systolic LV deformation compared to normal cats. Animals Seventy‐three client‐owned cats with (n = 37) and without (n = 36) preclinical HCM. Methods Retrospective echocardiographic study. Left and right ventricular longitudinal S and SR, LV radial and circumferential S and SR were calculated by STE. Left ventricular mass was also calculated. Correlation between STE variables and LV hypertrophy was determined and receiver‐operating characteristic (ROC) curves were plotted for prediction of HCM. Results Cats with HCM had smaller absolute longitudinal S (−14.8 ± 3.3% vs −19.7 ± 2.7%, P < .001), longitudinal SR (−2.36 ± 0.62 vs −2.95 ± 0.68 second−1, P < .001), radial S (46.2 ± 21.3% vs 66.7 ± 17.6%, P < .001), and radial SR (5.60 ± 2.08 vs 6.67 ± 1.8 second−1, P < .001) compared to healthy controls. No difference was observed for circumferential S and SR. Cats with HCM had greater LV mass (13.2 ± 3.7 g vs 8.6 ± 2.7 g, P < .001). The ROC with the greatest area under the curve (AUC) for the identification of HCM (0.974) was plotted from a logistic regression equation combining LV mass, MAPSE at the free wall, and LV internal diameter in diastole (LVIDd). Conclusions and clinical importance Cats with preclinical HCM have decreased long axis and radial deformation. Decreased longitudinal deformation and decreased LVIDd are factors that would support a diagnosis of HCM.
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Affiliation(s)
- Ilaria Spalla
- Clinical Science and Services, Royal Veterinary College, Hertfordshire, United Kingdom
| | - Adrian Boswood
- Clinical Science and Services, Royal Veterinary College, Hertfordshire, United Kingdom
| | - David J Connolly
- Clinical Science and Services, Royal Veterinary College, Hertfordshire, United Kingdom
| | - Virginia Luis Fuentes
- Clinical Science and Services, Royal Veterinary College, Hertfordshire, United Kingdom
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60
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Shi RY, An DA, Chen BH, Wu R, Wu CW, Du L, Zhu J, Jiang M, Xu JR, Wu LM. High T2-weighted signal intensity is associated with myocardial deformation in hypertrophic cardiomyopathy. Sci Rep 2019; 9:2644. [PMID: 30804397 PMCID: PMC6390098 DOI: 10.1038/s41598-019-39456-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 01/24/2019] [Indexed: 12/17/2022] Open
Abstract
The association between global and segmental myocardial strain impairment and fibrosis extent in hypertrophic cardiomyopathy (HCM) is widely verified. The aim of this study was to investigate the contribution of high T2-weighted signal intensity (HighT2) to myocardial deformation in HCM. We prospectively recruited 57 patients with HCM examined by a 3.0 Tesla magnetic resonance scanner with cine, T2-weighted imaging with fat saturation and phase-sensitive inversion recovery. Global and segmental radial, circumferential and longitudinal strains were included for analysis. The extent of HighT2 was negatively correlated with global radial strain (ρ = −0.275, p = 0.038) and positively correlated with global circumferential strain (ρ = 0.308, p = 0.02) and global longitudinal strain (ρ = 0.422, p = 0.001). Radial, circumferential and longitudinal strains were all significantly associated with segment thickness. Regarding circumferential strain, segments at the mid-ventricular level with LGE and HighT2 showed more impairment than segments with only LGE. For longitudinal strain, the influence of HighT2 appeared only at the mid-ventricular level. The HighT2 extent in HCM was observed to contribute to global and segmental strain parameters. At the segmental level, HighT2 indeed affects left ventricular deformation, and follow-up studies are still warranted.
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Affiliation(s)
- Ruo-Yang Shi
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Dong-Aolei An
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bing-Hua Chen
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Rui Wu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chong-Wen Wu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Liang Du
- Robotics Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Jiong Zhu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Meng Jiang
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jian-Rong Xu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Lian-Ming Wu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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61
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Huang MS, Lee WH, Tsai HR, Liu YW, Liu PY, Tsai WC. Value of layer-specific strain distribution patterns in hypertrophied myocardium from different etiologies. Int J Cardiol 2019; 281:69-75. [PMID: 30711265 DOI: 10.1016/j.ijcard.2019.01.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/20/2018] [Accepted: 01/10/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Intrinsic myocardial mechanics might have different patterns because of the different etiologies of myocardial hypertrophy. We used layer-specific strain to compare those with aortic stenosis (AS) and hypertrophic cardiomyopathy (HCM) and examined the differences in strain distribution pattern and for their clinical implications. METHODS Comprehensive echocardiography was done in 3 groups: 129 with moderate-to-severe AS, 172 consecutive patients with HCM, and 58 healthy controls. Left ventricle (LV) layer-specific deformation parameters were obtained using two-dimensional speckle tracking echocardiography. The transmural strain gradient was defined as the strain difference between subendocardial and subepicardial myocardium. Both diseased groups were further divided based on the median value of transmural strain gradient for the hemodynamics correlation. RESULTS Compared with the HCM group, the AS group had more preserved transmural longitudinal strain gradient (4.49 ± 1.3% vs. 3.61 ± 1.2%, p < 0.001), which was not significantly different from that of the healthy controls (4.49 ± 1.3% vs. 4.54 ± 1.0%, p = 0.975). And only in AS group the transmural circumferential strain correlated with myocardium mass index (r = -0.237, p = 0.008), and the hemodynamic profiles (LV ejection fraction and LA pressure) were correlated well with transmural strain gradient, in that the lower subgroup had a significantly lower LV ejection fraction and higher average E/E'. CONCLUSIONS Myocardium hypertrophy from different etiology resulted in different layer-specific strain distribution pattern. The loss of an adequate transmural strain gradient correlated with hemodynamics and might reflect intrinsic myocardial dysfunction.
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Affiliation(s)
- Mu-Shiang Huang
- Division of Cardiology, Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, Taiwan; Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan
| | - Wen-Huang Lee
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan
| | - Huey-Ru Tsai
- Division of Cardiology, Department of Internal Medicine, Madou Sin-Lau Hospital, Tainan, Taiwan
| | - Yen-Wen Liu
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan
| | - Ping-Yen Liu
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan
| | - Wei-Chuan Tsai
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan.
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Savino K, Bagliani G, Crusco F, Padeletti M, Lombardi M. Electrocardiogram and Imaging: An Integrated Approach to Arrhythmogenic Cardiomyopathies. Card Electrophysiol Clin 2019; 10:413-429. [PMID: 29784492 DOI: 10.1016/j.ccep.2018.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Cardiovascular imaging has radically changed the management of patients with arrhythmogenic cardiomyopathies. This article focuses on the role of echocardiography and MRI in the diagnosis of these structural diseases. Cardiomyopathies with hypertrophic pattern (hypertrophic cardiomyopathy, restrictive cardiomyopathies, amyloidosis, Anderson-Fabry disease, and sarcoidosis), cardiomyopathies with dilated pattern, inflammatory cardiac diseases, and right ventricular arrhythmogenic cardiomyopathy are analyzed. Finally, anatomic predictors of arrhythmias and sudden cardiac death are discussed. Each paragraph is attended by clinical cases that are discussed on the electrocardiogram, after integrated with the anatomic, functional, and hemodynamic modifications of cardiovascular imaging.
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Affiliation(s)
- Ketty Savino
- Cardiology and Cardiovascular Physiopathology, University of Perugia, Piazza Menghini, 1, Perugia 06129, Italy.
| | - Giuseppe Bagliani
- Arrhythmology Unit, Cardiology Department, Foligno General Hospital, Via Massimo Arcamone, Foligno 06034, Italy
| | - Federico Crusco
- Radiology, Foligno Hospital, Via Massimo Arcamone, Foligno 06034, Italy
| | - Margherita Padeletti
- Cardiology, Mugello Hospital, Viale della Resistenza, 60, 50032 Borgo San Lorenzo FI, Italy
| | - Massimo Lombardi
- Multimodality Cardiac Imaging Section, Policlinico San Donato, San Donato Milanese, Piazza Edmondo Malan, 2, 20097 San Donato Milanese MI, Italy
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Wu XP, Li YD, Zhang M, Zhu WW, Cai QZ, Jiang W, Sun LL, Ding XY, Ye XG, Qin YY, Lu XZ. Impaired left ventricular mechanics and functional reserve are associated with reduced exercise capacity in patients with hypertrophic cardiomyopathy. Echocardiography 2019; 36:266-275. [PMID: 30600556 DOI: 10.1111/echo.14241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 11/22/2018] [Accepted: 11/25/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Reduced metabolic equivalents (METs) are an indicator of exercise intolerance, which predicts poor prognosis in hypertrophic cardiomyopathy (HCM) patients. We sought to evaluate the changes in left ventricular (LV) mechanics and functional reserves, as well as their association with functional capacity in HCM patients. METHODS Seventy HCM patients and thirty controls were included in this study. LV mechanics were evaluated at rest and during exercise by echocardiography and two-dimensional speckle-tracking imaging to obtain parameters of functional reserve, LV global longitudinal strain (LVGLS), strain rate (SR), and circumferential strain. RESULTS Hypertrophic cardiomyopathy (HCM) patients had lower LVGLS, systolic SR, early and late diastolic SR at rest and during exercise, and reduced absolute and relative systolic and diastolic reserve compared to controls. LV circumferential strain was significantly higher at rest but lower during exercise in HCM patients. Exercise capacity was markedly reduced in HCM patients, and peak exercise LVGLS (LVGLS-exe) significantly correlated with exercise capacity. Multivariate regression analyses showed that LVGLS-exe, LV filling pressure during exercise (E/e'-exe), and LV mass index (LVMI) were independent predictors of exercise capacity. Moreover, LVGLS-exe displayed incremental predictive value over E/e'-exe and LVMI for exercise intolerance. Receiver operating characteristic curve analysis showed LVGLS-exe had optimal accuracy for predicting exercise intolerance in HCM patients. CONCLUSIONS Hypertrophic cardiomyopathy (HCM) patients have reduced LV mechanics at rest and during exercise and impaired mechanical reserve. LVGLS-exe is associated with exercise capacity and is an optimal predictive value for reduced exercise capacity in HCM patients.
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Affiliation(s)
- Xiao-Peng Wu
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| | - Yi-Dan Li
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| | - Miao Zhang
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| | - Wei-Wei Zhu
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| | - Qi-Zhe Cai
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| | - Wei Jiang
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| | - Lan-Lan Sun
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| | - Xue-Yan Ding
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| | - Xiao-Guang Ye
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| | - Yun-Yun Qin
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
| | - Xiu-Zhang Lu
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, China
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Radmilovic J, D'Andrea A, D'Amato A, Tagliamonte E, Sperlongano S, Riegler L, Scarafile R, Forni A, Muscogiuri G, Pontone G, Galderisi M, Russo MG. Echocardiography in Athletes in Primary Prevention of Sudden Death. J Cardiovasc Echogr 2019; 29:139-148. [PMID: 32089993 PMCID: PMC7011488 DOI: 10.4103/jcecho.jcecho_26_19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Echocardiography is a noninvasive imaging technique useful to provide clinical data regarding physiological adaptations of athlete's heart. Echocardiographic characteristics may be helpful for the clinicians to identify structural cardiac disease, responsible of sudden death during sport activities. The application of echocardiography in preparticipation screening might be essential: it shows high sensitivity and specificity for identification of structural cardiac disease and it is the first-line imagining technique for primary prevention of SCD in athletes. Moreover, new echocardiographic techniques distinguish extreme sport cardiac remodeling from beginning state of cardiomyopathy, as hypertrophic or dilated cardiomyopathy and arrhythmogenic right ventricle dysplasia. The aim of this paper is to review the scientific literature and the clinical knowledge about athlete's heart and main structural heart disease and to describe the rule of echocardiography in primary prevention of SCD in athletes.
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Affiliation(s)
- Juri Radmilovic
- Department of Cardiology, Umberto I, Nocera Inferiore, Italy.,Department of Cardiology, Luigi Vanvitelli University of Naples, Monaldi Hospital, Naples, Italy
| | - Antonello D'Andrea
- Department of Cardiology, Umberto I, Nocera Inferiore, Italy.,Department of Cardiology, Luigi Vanvitelli University of Naples, Monaldi Hospital, Naples, Italy
| | - Andrea D'Amato
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | | | - Simona Sperlongano
- Department of Cardiology, Luigi Vanvitelli University of Naples, Monaldi Hospital, Naples, Italy
| | - Lucia Riegler
- Department of Cardiology, Umberto I, Nocera Inferiore, Italy
| | | | - Alberto Forni
- Department of Cardiology, Umberto I, Nocera Inferiore, Italy
| | | | - Gianluca Pontone
- Department of Radiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Maria Giovanna Russo
- Department of Cardiology, Luigi Vanvitelli University of Naples, Monaldi Hospital, Naples, Italy
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Sun JP, Xu TY, Ni XD, Yang XS, Hu JL, Wang SC, Li Y, Bahler RC, Wang JG. Echocardiographic strain in hypertrophic cardiomyopathy and hypertensive left ventricular hypertrophy. Echocardiography 2018; 36:257-265. [PMID: 30561121 DOI: 10.1111/echo.14222] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/09/2018] [Accepted: 11/12/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The myocardial structure differs between secondary left ventricular hypertrophy (LVH) and hypertrophic cardiomyopathy (HCM). We investigated left ventricular function of these two types of hypertrophy using multilayer strain analysis with two-dimensional echocardiography. METHODS Transthoracic echocardiography (Vivid-E9) was performed in 240 patients with preserved left ventricular ejection fraction (LVEF ≥50%) and with either HCM (n = 80, 63 men, age 49.8 ± 14.1 years), hypertensive LVH (n = 80, 63 men, age 51.4 ± 13.3 years) or normal blood pressure and left ventricular structure (n = 80, 63 men, 50.8 ± 12.4 years). Quantitative multilayer longitudinal strain (LS), circumferential strain (CS), and radial strain (RS) were analyzed. The ratio of endo-/epi-myocardial strain was calculated. RESULTS Longitudinal strain was significantly (P < 0.001) lower in HCM patients than normal controls (15.2 ± 4.2% vs 23.1 ± 2.7%), especially in hypertrophic segments (14.5 ± 4.4% vs 17.2 ± 3.2% in nonhypertrophic segments, P < 0.01). LS was lower in patients with hypertensive LVH, similarly in all left ventricular segments (20.7 ± 3.7%, P < 0.001 vs controls). CS was lower in the mid- and epicardium (P < 0.01), but not endocardium in HCM (P = 0.4), and preserved in all myocardial layers in hypertensive LVH. The endo-/epi-myocardial ratios of both LS and CS were higher in HCM than hypertensive LVH (P < 0.01). RS was higher (P < 0.01) in HCM than hypertensive LVH and controls. Endocardial CS and global RS were correlated with LVEF (r ≥ 0.32, P < 0.01). CONCLUSIONS Hypertrophic cardiomyopathy patients had marked reductions in LS and CS, whereas patients with hypertensive LVH had less reduction in LS and preserved CS. The increased endo-/epi-myocardial ratios of LS and CS may be useful in differentiating HCM from hypertensive LVH.
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Affiliation(s)
- Jing-Ping Sun
- State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Center for Vascular Evaluations, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ting-Yan Xu
- State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Center for Vascular Evaluations, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xian-Da Ni
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xing-Sheng Yang
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jun-Li Hu
- Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Shao-Chun Wang
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yan Li
- State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Center for Vascular Evaluations, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Robert C Bahler
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Ji-Guang Wang
- State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Center for Vascular Evaluations, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Suzuki R, Mochizuki Y, Yoshimatsu H, Niina A, Teshima T, Matsumoto H, Koyama H. Layer-specific myocardial function in asymptomatic cats with obstructive hypertrophic cardiomyopathy assessed using 2-dimensional speckle-tracking echocardiography. J Vet Intern Med 2018; 33:37-45. [PMID: 30499128 PMCID: PMC6335538 DOI: 10.1111/jvim.15339] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 09/30/2018] [Accepted: 10/11/2018] [Indexed: 11/29/2022] Open
Abstract
Background Hypertrophic cardiomyopathy (HCM), a primary disorder of the myocardium, is the most common cardiac disease in cats. However, determination of layer‐specific myocardial function with 2D speckle‐tracking echocardiography in cats with asymptomatic HCM has not yet been reported. Objectives To quantitatively measure layer‐specific myocardial function of asymptomatic cats with HCM. Animals Ten client‐owned, asymptomatic cats with obstructive HCM and 13 healthy cats. Methods A retrospective, case‐control study. Cats underwent assessment of layer‐specific myocardial function (whole, endocardial, and epicardial) in the longitudinal and circumferential directions by using 2D speckle‐tracking echocardiography. Results Longitudinal strains were significantly lower in cats with HCM than controls in the whole (−15.5% vs −19.1%), endocardial (−18.3% vs −21.8%), and epicardial (−13.1% vs −16.8%) layers. Circumferential strains in whole and epicardial layers also were significantly lower in cats with HCM as compared with controls (−15.0% vs −20.2% and − 4.4% vs −9.4%, respectively). However, no significant difference was found between cats with HCM and controls in the global circumferential strain in the endocardial layer (−31.2% vs −34.2%). The circumferential endocardial‐to‐epicardial strain ratio was significantly higher in cats with HCM than in controls (6.1 vs 3.5). Conclusions and Clinical Importance Layer‐specific myocardial function assessed by 2D speckle‐tracking echocardiography differed in asymptomatic cats with obstructive HCM compared to controls despite their apparently normal systolic function, as determined by conventional echocardiography. The maintained endocardial circumferential strain and higher circumferential endocardial‐to‐epicardial strain ratio may reflect compensation for occult systolic dysfunction in cats with obstructive HCM.
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Affiliation(s)
- Ryohei Suzuki
- Laboratory of Veterinary Internal Medicine, Division of Therapeutic Sciences 1, Department of Veterinary Clinical Medicine, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Yohei Mochizuki
- Laboratory of Veterinary Internal Medicine, Division of Therapeutic Sciences 1, Department of Veterinary Clinical Medicine, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Hiroki Yoshimatsu
- Laboratory of Veterinary Internal Medicine, Division of Therapeutic Sciences 1, Department of Veterinary Clinical Medicine, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Ayaka Niina
- Laboratory of Veterinary Internal Medicine, Division of Therapeutic Sciences 1, Department of Veterinary Clinical Medicine, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Takahiro Teshima
- Laboratory of Veterinary Internal Medicine, Division of Therapeutic Sciences 1, Department of Veterinary Clinical Medicine, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Hirotaka Matsumoto
- Laboratory of Veterinary Internal Medicine, Division of Therapeutic Sciences 1, Department of Veterinary Clinical Medicine, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Hidekazu Koyama
- Laboratory of Veterinary Internal Medicine, Division of Therapeutic Sciences 1, Department of Veterinary Clinical Medicine, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, Tokyo, Japan
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Huang X, Yue Y, Wang Y, Deng Y, Liu L, Di Y, Sun S, Chen D, Fan L, Cao J. Assessment of left ventricular systolic and diastolic abnormalities in patients with hypertrophic cardiomyopathy using real-time three-dimensional echocardiography and two-dimensional speckle tracking imaging. Cardiovasc Ultrasound 2018; 16:23. [PMID: 30285887 PMCID: PMC6167824 DOI: 10.1186/s12947-018-0142-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 09/05/2018] [Indexed: 11/23/2022] Open
Abstract
Background Conventional echocardiography is not sensitive enough to assess left ventricular (LV) dysfunction in hypertrophic cardiomyopathy (HCM) patients. This research attempts to find a new ultrasonic technology to better assess LV diastolic function, systolic function, and myocardial longitudinal and circumferential systolic strain of segments with different thicknesses in HCM patients. Methods This study included 50 patients with HCM and 40 healthy subjects as controls. The peak early and late mitral annulus diastolic velocities at six loci (Ea′ and Aa′, respectively) and the Ea′/Aa′ ratio were measured using real-time tri-plane echocardiography and quantitative tissue velocity imaging (RT-3PE-QTVI). The mean value of Ea′ at six loci (Em′) was obtained for the calculation of E/Em′ ratio. The LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), LV stroke volume (LVSV), and LV ejection fraction (LVEF) were measured using real-time three-dimensional echocardiography (RT-3DE). LV myocardial longitudinal peak systolic strain (LPSS) and circumferential peak systolic strain (CPSS) in the apical-middle-basal segments (LPSS-api, LPSS-mid, LPSS-bas; CPSS-api, CPSS-mid, and CPSS-bas, respectively) were obtained using a software for two-dimensional speckle tracking imaging (2D-STI). According to the different segmental thicknesses (STs) in each HCM patient, the values (LPSS and CPSS) of all the myocardial segments were categorized into three groups and the respective averages were computed. Results The Ea′, Aa′, and, Ea′/Aa’ ratio in HCM patients were lower than those in the controls (all p < 0.001), while the E/Em′ ratio in HCM patients was higher than that in the controls (p < 0.001). The LVEDV, LVSV, and LVEF were significantly lower in HCM patients than in controls (all p < 0.001). In HCM patients, the LPSS-api, LPSS-mid, LPSS-bas, CPSS-api, CPSS-mid, and CPSS-bas and the LPSS and CPSS of LV segments with different thicknesses were all significantly reduced (all p < 0.001). Conclusions In HCM patients, myocardial dysfunction was widespread not only in the obviously hypertrophic segments but also in the non-hypertrophic segments; the LV systolic and diastolic functions were damaged, even with a normal LVEF. LV diastolic dysfunction, systolic dysfunction, and myocardial deformation impairment in HCM patients can be sensitively revealed by RT-3PE-QTVI, RT-3DE, and 2D-STI.
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Affiliation(s)
- Xin Huang
- Department of cardiology, Nanlou Division, Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, 100853, China
| | - Yan Yue
- Department of medical administration, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yinmeng Wang
- Department of Respiration, Clifford Hospital, Guangzhou, 511495, China
| | - Yujiao Deng
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, 100853, China
| | - Lu Liu
- Department of cardiology, Nanlou Division, Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, 100853, China
| | - Yanqi Di
- Department of cardiology, Nanlou Division, Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, 100853, China
| | - Shasha Sun
- Department of cardiology, Nanlou Division, Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, 100853, China
| | - Deyou Chen
- Department of Outpatient, Chinese PLA General Hospital, Beijing, 100853, China
| | - Li Fan
- Department of cardiology, Nanlou Division, Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, 100853, China
| | - Jian Cao
- Department of cardiology, Nanlou Division, Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, 100853, China.
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Tower-Rader A, Mohananey D, To A, Lever HM, Popovic ZB, Desai MY. Prognostic Value of Global Longitudinal Strain in Hypertrophic Cardiomyopathy: A Systematic Review of Existing Literature. JACC Cardiovasc Imaging 2018; 12:1930-1942. [PMID: 30219395 DOI: 10.1016/j.jcmg.2018.07.016] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/13/2018] [Accepted: 07/19/2018] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The association of left ventricular global longitudinal strain (LV-GLS) with clinical outcomes in patients with hypertrophic cardiomyopathy (HCM) has been examined in multiple studies. The authors conducted a systematic review aimed at summarizing and critically appraising the current evidence. BACKGROUND HCM is a common genetic cardiovascular disease with an estimated prevalence of 1 in 500 patients. LV-GLS derived from speckle tracking echocardiography is a sensitive noninvasive method of assessing regional left ventricular function. Several studies have suggested association of abnormal LV-GLS with outcomes in HCM patients. METHODS A computerized literature search of all English language publications in the PubMed and EMBASE databases was made looking at all randomized and nonrandomized studies conducted on patients with HCM where association of LV-GLS with clinical outcomes was studied. We then manually searched the reference lists of included articles. The Preferred Reporting Items for Systematic reviews and Meta-Analyses statement (PRISMA) of reporting systematic reviews was used. RESULTS Our search yielded a total of 14 observational studies published between 2009 and 2017 with a total of 3,154 patients with HCM. Eleven of the 14 studies included a composite cardiac outcome which included mortality as their primary outcome of interest and 3 of the 14 studies looked at association of LV-GLS with ventricular arrhythmias and/or implantable cardiac defibrillator discharge. We noted wide variability in inclusion, methodology, follow-up, and consequently effect estimates, which was not conducive to performing a meta-analysis. However, despite the variation, all studies revealed a degree of association of abnormal LV-GLS with poor cardiac outcomes. CONCLUSIONS Our systematic review of more than 3000 HCM patients suggests an association of abnormal LV-GLS with adverse composite cardiac outcomes and ventricular arrhythmias.
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Affiliation(s)
| | | | - Andrew To
- Hypertrophic Cardiomyopathy Center, Cleveland Clinic, Cleveland, Ohio; Northshore Hospital, Auckland, New Zealand
| | - Harry M Lever
- Hypertrophic Cardiomyopathy Center, Cleveland Clinic, Cleveland, Ohio
| | - Zoran B Popovic
- Hypertrophic Cardiomyopathy Center, Cleveland Clinic, Cleveland, Ohio
| | - Milind Y Desai
- Hypertrophic Cardiomyopathy Center, Cleveland Clinic, Cleveland, Ohio.
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Investigation of myocardial dysfunction using three-dimensional speckle tracking echocardiography in a genetic positive hypertrophic cardiomyopathy Chinese family. Cardiol Young 2018; 28:1106-1114. [PMID: 29978770 DOI: 10.1017/s1047951118000860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND We previously reported four heterozygous missense mutations of MYH7, KCNQ1, MYLK2, and TMEM70 in a single three-generation Chinese family with dual Long QT and hypertrophic cardiomyopathy phenotypes for the first time. However, the clinical course among the family members was various, and the potential myocardial dysfunction has not been investigated. OBJECTIVES The objective of this study was to investigate the echocardiographic and electrocardiographic characteristics in a genetic positive Chinese family with hypertrophic cardiomyopathy and further to explore the association between myocardial dysfunction and electric activity, and the identified mutations. METHODS A comprehensive echocardiogram - standard two-dimensional Doppler echocardiography and three-dimensional speckle tracking echocardiography - and electrocardiogram were obtained for members in this family. RESULTS As previously reported, four missense mutations - MYH7-H1717Q, KCNQ1-R190W, MYLK2-K324E, and TMEM70-I147T - were identified in this family. The MYH7-H1717Q mutation carriers had significantly increased left ventricular mass indices, elevated E/e' ratio, deteriorated global longitudinal stain, but enhanced global circumferential and radial strain compared with those in non-mutation patients (all p<0.05). The KCNQ1-R190W carriers showed significantly prolonged QTc intervals, and the MYLK2-K324E mutation carriers showed inverted T-waves (both p<0.05). However, the TMEM70-I147T mutation carriers had similar echocardiography and electrocardiographic data as non-mutation patients. CONCLUSIONS Three of the identified four mutations had potential pathogenic effects in this family: MYH7-H1717Q was associated with increased left ventricular thickness, elevated left ventricular filling pressure, and altered myocardial deformation; KCNQ1-R190W and MYLK2-K324E mutations were correlated with electrocardiographic abnormalities reflected in long QT phenotype and inverted T-waves, respectively.
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70
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Loncaric F, Bijnens B, Sitges M. Added value of cardiac deformation imaging in differential diagnosis of left ventricular hypertrophy. Glob Cardiol Sci Pract 2018; 2018:21. [PMID: 30393633 PMCID: PMC6209440 DOI: 10.21542/gcsp.2018.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Filip Loncaric
- Cardiovascular Institute, Hospital Clínic, University of Barcelona & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
| | - Bart Bijnens
- Universitat Pompeu Fabra, Barcelona, Spain.,ICREA, Barcelona, Spain
| | - Marta Sitges
- Cardiovascular Institute, Hospital Clínic, University of Barcelona & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
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Pagourelias ED, Mirea O, Vovas G, Duchenne J, Michalski B, Van Cleemput J, Bogaert J, Vassilikos VP, Voigt JU. Relation of regional myocardial structure and function in hypertrophic cardiomyopathy and amyloidois: a combined two-dimensional speckle tracking and cardiovascular magnetic resonance analysis. Eur Heart J Cardiovasc Imaging 2018; 20:426-437. [DOI: 10.1093/ehjci/jey107] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/12/2018] [Accepted: 07/10/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Efstathios D Pagourelias
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, Leuven, Belgium
- Third Cardiology Department, Hippokrateion University Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Str, Thessaloniki, Greece
| | - Oana Mirea
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, University County Hospital of Craiova, 1 Tabaci Str, Craiova, Romania
| | - Georgios Vovas
- Department of Radiology, University Hospital Leuven, Catholic University Leuven, Herestraat 49, Leuven, Belgium
| | - Jürgen Duchenne
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, Leuven, Belgium
| | - Blazej Michalski
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, Leuven, Belgium
| | - Johan Van Cleemput
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, Leuven, Belgium
| | - Jan Bogaert
- Department of Radiology, University Hospital Leuven, Catholic University Leuven, Herestraat 49, Leuven, Belgium
| | - Vasilios P Vassilikos
- Third Cardiology Department, Hippokrateion University Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Str, Thessaloniki, Greece
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, Leuven, Belgium
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Hinojar R, Fernández-Golfín C, González-Gómez A, Rincón LM, Plaza-Martin M, Casas E, García-Martín A, Fernandez-Mendez MA, Esteban A, Nacher JJJ, Zamorano JL. Prognostic implications of global myocardial mechanics in hypertrophic cardiomyopathy by cardiovascular magnetic resonance feature tracking. Relations to left ventricular hypertrophy and fibrosis. Int J Cardiol 2018; 249:467-472. [PMID: 29121751 DOI: 10.1016/j.ijcard.2017.07.087] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 07/05/2017] [Accepted: 07/21/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND Interstitial fibrosis, myocardial fiber disarray and non-uniform shortening are common histological features of hypertrophic cardiomyopathy (HCM). The degree of LV hypertrophy and fibrosis are postulated to contribute to the impairment of myocardial shortening. Cardiovascular magnetic resonance myocardial (CMR) feature tracking (CMR-FT) has emerged as a robust method that provides quantitative measurements of myocardial deformation. Our aim was first to evaluate LV strain parameters in HCM by CMR-FT and their dependence on both functional parameters and late gadolinium enhancement (LGE); and secondly we sought to determine their association with major cardiovascular outcomes. METHODS AND RESULTS 74 patients with HCM and 75 controls subjects underwent a CMR study including LGE imaging. Global peak longitudinal, circumferential and radial systolic strain values (GLS, GCS, GRS) were measured by CMR-FT. A primary endpoint of all-cause mortality and secondary combined endpoint of hospital admission related to heart failure, lethal ventricular arrhythmias or cardiovascular death were defined. Patients with HCM showed attenuation of all LV strain values (p<0.001). Multivariate analysis showed that both LV hypertrophy and %of LGE were independent predictors of attenuated LV strains. All systolic LV strain parameters were impaired in patients with primary and secondary endpoints (follow up time: 25.6±9.9months, p<0.05 and p<0.01 respectively). Abnormal GLS, GCS and GRS were significantly associated with primary and secondary endpoints. CONCLUSION Both LV hypertrophy and fibrosis contribute to the impairment of LV myocardial mechanics in HCM. In this population, reduced LV strain is associated with poor cardiac outcomes, particularly cardiovascular mortality and HF.
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Affiliation(s)
- Rocio Hinojar
- Cardiology Department, University Hospital Ramón y Cajal, Madrid, Spain; University Alcala, Madrid, Spain.
| | - Covadonga Fernández-Golfín
- Cardiology Department, University Hospital Ramón y Cajal, Madrid, Spain; University Alcala, Madrid, Spain; CIBERCV, Instituto de Salud Carlos III (ISCIII), Spain
| | | | - Luis Miguel Rincón
- Cardiology Department, University Hospital Ramón y Cajal, Madrid, Spain; University Alcala, Madrid, Spain; CIBERCV, Instituto de Salud Carlos III (ISCIII), Spain
| | | | - Eduardo Casas
- Cardiology Department, University Hospital Ramón y Cajal, Madrid, Spain
| | - Ana García-Martín
- Cardiology Department, University Hospital Ramón y Cajal, Madrid, Spain
| | | | - Amparo Esteban
- Radiology Department, University Hospital Ramón y Cajal, Madrid, Spain
| | | | - Jose Luis Zamorano
- Cardiology Department, University Hospital Ramón y Cajal, Madrid, Spain; University Alcala, Madrid, Spain; CIBERCV, Instituto de Salud Carlos III (ISCIII), Spain
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73
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Spalla I, Payne JR, Borgeat K, Luis Fuentes V, Connolly DJ. Prognostic value of mitral annular systolic plane excursion and tricuspid annular plane systolic excursion in cats with hypertrophic cardiomyopathy. J Vet Cardiol 2018; 20:154-164. [DOI: 10.1016/j.jvc.2018.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 03/26/2018] [Accepted: 04/03/2018] [Indexed: 12/31/2022]
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Gianturco L, Bodini B, Gianturco V, Lippo G, Solbiati A, Turiel M. Left ventricular longitudinal strain in soccer referees. Oncotarget 2018; 8:39766-39773. [PMID: 28199991 PMCID: PMC5503651 DOI: 10.18632/oncotarget.15242] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/31/2016] [Indexed: 01/20/2023] Open
Abstract
Along the years, the analysis of soccer referees perfomance has interested the experts and we can find several types of studies in literature using in particular cardiac imaging. The aim of this retrospective study was to observe relationship between VO2max uptake and some conventional and not-conventional echocardiographic parameters. In order to perform this evaluation, we have enrolled 20 referees, belonging to Italian Soccer Referees' Association and we have investigated cardiovascular profile of them. We found a strong direct relationship between VO2max and global longitudinal strain of left ventricle assessed by means of speckle tracking echocardiographic analysis (R2=0.8464). The most common classic echocardiographic indexes have showed mild relations (respectively, VO2max vs EF: R2=0.4444; VO2max vs LV indexed mass: R2=0.2268). Therefore, our study suggests that longitudinal strain could be proposed as a specific echocardiographic parameter to evaluate the soccer referees performance.
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Affiliation(s)
- Luigi Gianturco
- IRCCS Galeazzi Orthopedic Institute, Cardiology Unit, Milan, Italy
| | - Bruno Bodini
- IRCCS Galeazzi Orthopedic Institute, Rehabilitation Unit, Milan, Italy
| | | | - Giuseppina Lippo
- Department of Occupational and Environmental Health University of Milan, IRCCS Fondazione Policlinico Mangiagalli Regina Elena, Milan, Italy
| | - Agnese Solbiati
- IRCCS Galeazzi Orthopedic Institute, Cardiology Unit, Milan, Italy
| | - Maurizio Turiel
- IRCCS Galeazzi Orthopedic Institute, Cardiology Unit, Milan, Italy
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75
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Sanz-Estébanez S, Cordero-Grande L, Sevilla T, Revilla-Orodea A, de Luis-García R, Martín-Fernández M, Alberola-López C. Vortical features for myocardial rotation assessment in hypertrophic cardiomyopathy using cardiac tagged magnetic resonance. Med Image Anal 2018; 47:191-202. [PMID: 29753999 DOI: 10.1016/j.media.2018.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 01/10/2018] [Accepted: 03/14/2018] [Indexed: 11/16/2022]
Abstract
Left ventricular rotational motion is a feature of normal and diseased cardiac function. However, classical torsion and twist measures rely on the definition of a rotational axis which may not exist. This paper reviews global and local rotation descriptors of myocardial motion and introduces new curl-based (vortical) features built from tensorial magnitudes, intended to provide better comprehension about fibrotic tissue characteristics mechanical properties. Fifty-six cardiomyopathy patients and twenty-two healthy volunteers have been studied using tagged magnetic resonance by means of harmonic phase analysis. Rotation descriptors are built, with no assumption about a regular geometrical model, from different approaches. The extracted vortical features have been tested by means of a sequential cardiomyopathy classification procedure; they have proven useful for the regional characterization of the left ventricular function by showing great separability not only between pathologic and healthy patients but also, and specifically, between heterogeneous phenotypes within cardiomyopathies.
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Affiliation(s)
- Santiago Sanz-Estébanez
- Laboratorio de Procesado de Imagen, Department of Teoría de la Señal y Comunicaciones e Ingeniería Telemática, ETSIT, Universidad de Valladolid, Campus Miguel Delibes s.n., Valladolid 40011, Spain. http://www.lpi.tel.uva.es/ssanest
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain and Department of Biomedical Engineering, Division of Imaging Science and Biomedical Engineering, King's College London, St Thomas' Hospital, London SE1 7EH, U.K.
| | - Teresa Sevilla
- Unidad de Imagen Cardiaca, Hospital Clínico Universitario de Valladolid, CIBER de enfermedades cardiovasculares (CIBERCV), Valladolid 47005, Spain
| | - Ana Revilla-Orodea
- Unidad de Imagen Cardiaca, Hospital Clínico Universitario de Valladolid, CIBER de enfermedades cardiovasculares (CIBERCV), Valladolid 47005, Spain
| | - Rodrigo de Luis-García
- Laboratorio de Procesado de Imagen, Department of Teoría de la Señal y Comunicaciones e Ingeniería Telemática, ETSIT, Universidad de Valladolid, Campus Miguel Delibes s.n., Valladolid 40011, Spain.
| | - Marcos Martín-Fernández
- Laboratorio de Procesado de Imagen, Department of Teoría de la Señal y Comunicaciones e Ingeniería Telemática, ETSIT, Universidad de Valladolid, Campus Miguel Delibes s.n., Valladolid 40011, Spain.
| | - Carlos Alberola-López
- Laboratorio de Procesado de Imagen, Department of Teoría de la Señal y Comunicaciones e Ingeniería Telemática, ETSIT, Universidad de Valladolid, Campus Miguel Delibes s.n., Valladolid 40011, Spain.
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Abstract
PURPOSE OF REVIEW Left ventricular (LV) outflow tract (LVOT) obstruction (LVOTO) is not unusual in ICU patients particularly with septic shock. RECENT FINDINGS LVOT was first described in patients with hypertrophic cardiomyopathy and was defined as LV wall thickness at least 15 mm. LVOT is usually because of systolic anterior motion of the mitral valve. By convention, LVOTO is defined as an instantaneous peak Doppler LVOT pressure gradient at least 30 mmHg at rest or during physiological provocation such as Valsalva maneuver. Recently, it has been demonstrated that LVOT can be present in patients with severe hypovolemia or hyperkinesia with or without LV hypertrophy and can lead to hemodynamic compromise. LVOT is because of a combination of precipitating factors, which may or may not be associated with anatomical abnormalities. Decreased preload because of hypovolemia or decreased afterload because of septic shock, increased heart rate, and LV hyperkinesis produced by dobutamine infusion can induce a change of LV shape and induce LVOTO. SUMMARY LVOTO is not uncommon in ICU patients and can be observed at the early phase of septic shock. Treatment should include discontinuation of dobutamine infusion and fluid infusion. β blockers can be useful in this clinical situation.
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77
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Ji L, Hu W, Yong Y, Wu H, Zhou L, Xu D. Left ventricular energy loss and wall shear stress assessed by vector flow mapping in patients with hypertrophic cardiomyopathy. Int J Cardiovasc Imaging 2018; 34:1383-1391. [PMID: 29626283 DOI: 10.1007/s10554-018-1348-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
Abstract
The aim of this study was to assess left ventricular (LV) summation of energy loss (EL-SUM), average energy loss (EL-AVE) and wall shear stress (WSS) using vector flow mapping (VFM) in patients with hypertrophic cardiomyopathy (HCM). Forty HCM patients, and 40 controls were evaluated by transthoracic echocardiography. Conventional echocardiographic parameters, summation and average of energy loss (EL-total, EL-base, EL-mid and EL-apex), and WSS in each segment were calculated at different phases. Compared with controls, conventional diastolic measurements were impaired in HCM patients. HCM patients also showed increased EL-SUM-total and EL-AVE-total at the peak of LV rapid ejection period as well as decreased EL-SUM-total and EL-AVE-total at the end of early diastole. In controls, EL-SUM and EL-AVE showed a gradual decrease from the basal segment to the apex, this regularity was not observed in HCM patients. Compared with controls, HCM patients showed increased WSS at the peak of the LV rapid ejection period and the atrial contraction period as well as decreased WSS at the end of early diastole (all p < 0.05). WSS was increased slightly at the peak of the LV rapid filling period in HCM patients (p = 0.055). EL and WSS values derived from VFM are novel flow dynamic parameters that can effectively evaluate systolic and diastolic hemodynamic function in HCM patients.
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Affiliation(s)
- Ling Ji
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wenzhi Hu
- Department of Cardiology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yonghong Yong
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hongping Wu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lei Zhou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Di Xu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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79
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Wu R, An DA, Shi RY, Chen BH, Jiang M, Bacyinski A, Han TT, Hu J, Xu JR, Wu LM. Myocardial fibrosis evaluated by diffusion-weighted imaging and its relationship to 3D contractile function in patients with hypertrophic cardiomyopathy. J Magn Reson Imaging 2018; 48:1139-1146. [PMID: 29601139 DOI: 10.1002/jmri.26016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 03/02/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Previous studies have shown that diffusion-weighted imaging (DWI) is sensitive to myocardial fibrosis in ischemic and nonischemic cardiomyopathy. PURPOSE To explore the prognostic value of apparent diffusion coefficient (ADC) for detecting myocardial fibrosis and its relationship to the contractile function in hypertrophic cardiomyopathy (HCM). STUDY TYPE Prospective. POPULATION A total of 45 HCM patients and 20 controls. FIELD STRENGTH/SEQUENCE 3.0T cardiac MRI. The cardiac MR sequences included cine, T1 mapping, and DWI. ASSESSMENT According to the presence of late gadolinium enhancement (LGE) and the extracellular volume (ECV) values (+2 SD of control subjects), respectively, reader W and reader J assessed the value of ADC of each segment for detecting myocardial fibrosis and its relationship to impaired contractile function in HCM patients. STATISTICAL TESTS Independent sample t-test, Pearson analysis, and intraclass correlation (ICC). RESULTS The value of ECV was 23.6 ± 3.0% for control. ECV ≥ 29.6% and ECV < 29.6% groups were classified. ADC values in the ECV ≥ 29.6% group were significantly increased compared to the ECV < 29.6% group, (2.41 ± 0.23 μm2 /ms vs. 2.03 ± 0.16 μm2 /ms, P < 0.005). Compared to the LGE - group, ECV (32.1 ± 2.3% vs. 29.0 ± 2.8%, P < 0.005) and ADC (2.60 ± 0.18 μm2 /ms vs. 2.10 ± 0.07 μm2 /ms, P < 0.005) values were significantly increased in the LGE + group. ADC values were linearly associated with ECV values (R2 = 0.65) in HCM patients. ADC values were linearly associated with circumferential and longitudinal strain (R2 = 0.60, R2 = 0.46), as well as circumferential, longitudinal, and radial strain rate (R2 = 0.13, R2 = 0.25, R2 = 0.17, respectively). DATA CONCLUSION Contractile dysfunction in HCM is predominantly associated with ADC, which is a feasible alternative to ECV and LGE for detecting myocardial fibrosis. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;48:1139-1146.
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Affiliation(s)
- Rui Wu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Dong-Aolei An
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ruo-Yang Shi
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bing-Hua Chen
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Meng Jiang
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Andrew Bacyinski
- Department of Physical Medicine and Rehabilitation, Detroit Medical Center, Detroit, Michigan, USA
| | - Tong-Tong Han
- Circle Cardiovascular Imaging Inc., Calgary, AB, Canada
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, Michigan, USA
| | - Jian-Rong Xu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lian-Ming Wu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Inciardi RM, Galderisi M, Nistri S, Santoro C, Cicoira M, Rossi A. Echocardiographic advances in hypertrophic cardiomyopathy: Three-dimensional and strain imaging echocardiography. Echocardiography 2018; 35:716-726. [DOI: 10.1111/echo.13878] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Riccardo M. Inciardi
- Division of Cardiology; Department of Medicine; University of Verona; Verona Italy
| | - Maurizio Galderisi
- Departement of Advanced Biomedical Science; Federico II University; Naples Italy
| | - Stefano Nistri
- Cardiology Service; CMSR-Veneto Medica; Altavilla Vicentina Italy
| | - Ciro Santoro
- Departement of Advanced Biomedical Science; Federico II University; Naples Italy
| | | | - Andrea Rossi
- Division of Cardiology; Department of Medicine; University of Verona; Verona Italy
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81
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Funabashi N, Takaoka H, Ozawa K, Uehara M, Komuro I, Kobayashi Y. 2D speckle-tracking TTE-based quantitative classification of left ventricular myocardium in patients with hypertrophic cardiomyopathy by the presence or the absence of fibrosis and/or hypertrophy. Heart Vessels 2018; 33:1046-1051. [PMID: 29569032 DOI: 10.1007/s00380-018-1155-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 03/16/2018] [Indexed: 01/02/2023]
Abstract
We used peak longitudinal strain (PLS) on TTE in HCM patients to differentiate LV myocardium (LVM) into the following 4 groups: group 1-no fibrosis or hypertrophy (≥ 13 mm), group 2-no fibrosis but hypertrophy evident, group 3-fibrosis present but without hypertrophy, and group 4-both fibrosis and hypertrophy. Seventeen HCM patients (13 males, 56 ± 16 years) underwent both 1.5 T CMR and TTE. On TTE, PLS (absolute values) for each LVM segment from 17 AHA-defined lesions was calculated. Of 289 LVM lesions, the numbers in each group, 1-4, were 156, 53, 39, and 41, respectively. PLS for LVM segments in group 1 (13.6 ± 6.4%) were significantly greater than those in group 2 (8.5 ± 4.9%, P < 0.001), group 3 (10.4 ± 5.0%, P = 0.006), and group 4 (7.1 ± 4.4%, P < 0.001). PLS for LVM segments in group 3 was significantly greater than those in group 4 (P = 0.016). However, significant differences in PLS in LVM between groups 2 and 3, and between 2 and 4 were not observed. Using regional PLS, we demonstrate successful differentiation of LVM in HCM patients for group 1 (LVM with zero fibrosis or hypertrophy) from LVM belonging to groups 2-4 and we also demonstrate successful differentiation of LVM with fibrosis present but without hypertrophy from LVM with both fibrosis and hypertrophy. However, it is not possible to differentiate between LVM with no fibrosis but hypertrophy evident and those with fibrosis present but without hypertrophy and also between LVM with no fibrosis but hypertrophy evident and those with both fibrosis and hypertrophy. Our findings have significant implications for the management of HCM patients.
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Affiliation(s)
- Nobusada Funabashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan.
| | - Hiroyuki Takaoka
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Koya Ozawa
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Masae Uehara
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
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Huang J, Yan ZN, Rui YF, Fan L, Liu C, Li J. Left ventricular short-axis systolic function changes in patients with hypertrophic cardiomyopathy detected by two-dimensional speckle tracking imaging. BMC Cardiovasc Disord 2018; 18:13. [PMID: 29378516 PMCID: PMC5789668 DOI: 10.1186/s12872-018-0753-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is a genetic disease was characterised by left ventricular hypertrophy (LVH), myocardial fibrosis, fiber disarray. The short-axis systolic function is important in left ventricle function. METHODS Forty one healthy subjects and 37 HCM patients were enrolled for this research. Parasternal short-axis at the basal, middle, and apical levels were acquired by Echocardiography. The peak systolic circumferential strain of the endocardial, the middle and the epicardial layers, the peak systolic radial strain, and the peak systolic rotational degrees at different short-axis levels were measured by 2-dimensional speckle tracking imaging (2D-STI). RESULTS The peak systolic circumferential strain of the septum and anterior walls in HCM patients was significantly lower than normal subjects. All of the peak systolic radial strain in HCM patients was significantly lower than normal subjects. The rotational degrees at the base and middle short-axis levels in HCM patients were larger than normal subjects. The interventricular septal thickness in end-diastolic period correlated to the peak systolic circumferential strain of the septum wall. CONCLUSIONS The short-axis systolic function was impaired in HCM patients. The peak circumferential systolic strain of the different layers, peak systolic radial strain and rotation degrees of the different short-axis levels detected by 2D-STI are very feasible for assessing the short-axis function in HCM patients.
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Affiliation(s)
- Jun Huang
- Department of Echocardiography, the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China.
| | - Zi-Ning Yan
- Department of Echocardiography, the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Yi-Fei Rui
- Department of Echocardiography, the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Li Fan
- Department of Echocardiography, the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Chang Liu
- Department of Echocardiography, the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Jie Li
- Department of Echocardiography, the Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China
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83
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Marian AJ, Braunwald E. Hypertrophic Cardiomyopathy: Genetics, Pathogenesis, Clinical Manifestations, Diagnosis, and Therapy. Circ Res 2017; 121:749-770. [PMID: 28912181 DOI: 10.1161/circresaha.117.311059] [Citation(s) in RCA: 725] [Impact Index Per Article: 103.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is a genetic disorder that is characterized by left ventricular hypertrophy unexplained by secondary causes and a nondilated left ventricle with preserved or increased ejection fraction. It is commonly asymmetrical with the most severe hypertrophy involving the basal interventricular septum. Left ventricular outflow tract obstruction is present at rest in about one third of the patients and can be provoked in another third. The histological features of HCM include myocyte hypertrophy and disarray, as well as interstitial fibrosis. The hypertrophy is also frequently associated with left ventricular diastolic dysfunction. In the majority of patients, HCM has a relatively benign course. However, HCM is also an important cause of sudden cardiac death, particularly in adolescents and young adults. Nonsustained ventricular tachycardia, syncope, a family history of sudden cardiac death, and severe cardiac hypertrophy are major risk factors for sudden cardiac death. This complication can usually be averted by implantation of a cardioverter-defibrillator in appropriate high-risk patients. Atrial fibrillation is also a common complication and is not well tolerated. Mutations in over a dozen genes encoding sarcomere-associated proteins cause HCM. MYH7 and MYBPC3, encoding β-myosin heavy chain and myosin-binding protein C, respectively, are the 2 most common genes involved, together accounting for ≈50% of the HCM families. In ≈40% of HCM patients, the causal genes remain to be identified. Mutations in genes responsible for storage diseases also cause a phenotype resembling HCM (genocopy or phenocopy). The routine applications of genetic testing and preclinical identification of family members represents an important advance. The genetic discoveries have enhanced understanding of the molecular pathogenesis of HCM and have stimulated efforts designed to identify new therapeutic agents.
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Affiliation(s)
- Ali J Marian
- From the Center for Cardiovascular Genetics, Institute of Molecular Medicine, Department of Medicine, University of Texas Health Sciences Center at Houston (A.J.M.); Texas Heart Institute, Houston (A.J.M.); and TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.B.).
| | - Eugene Braunwald
- From the Center for Cardiovascular Genetics, Institute of Molecular Medicine, Department of Medicine, University of Texas Health Sciences Center at Houston (A.J.M.); Texas Heart Institute, Houston (A.J.M.); and TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.B.)
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84
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Structural and Functional Correlates of Myocardial T1 Mapping in 321 Patients With Hypertrophic Cardiomyopathy. J Comput Assist Tomogr 2017; 41:653-660. [PMID: 27997439 DOI: 10.1097/rct.0000000000000564] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the structural and functional correlates of T1 mapping in 321 patients with hypertrophic cardiomyopathy (HCM). METHODS Three hundred twenty-one patients with HCM who underwent cardiac magnetic resonance from 2003 to 2013 were retrospectively identified from our institution's HCM registry. Left ventricular volume, function, late gadolinium enhancement (LGE), and Look-Locker T1 time were quantified. T1 time was normalized to blood pool to calculate T1 ratio. Correlations between LGE%, T1 ratio, and structural and functional features were performed using Pearson correlation coefficient. RESULTS Late gadolinium enhancement showed stronger correlation with left ventricular mass index (r = 0.41, P < 0.001) compared with T1 ratio (r = -0.17, P = 0.004). Both LGE% and T1 ratio correlated with ejection fraction (r = -0.18 and P = 0.002 vs r = 0.21 and P < 0.001, respectively). E/e' showed correlation with LGE% but not with T1 ratio. CONCLUSIONS Late gadolinium enhancement was more strongly correlated with the phenotypic expression of HCM compared with T1 ratio.
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85
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Huang J, Yan ZN, Fan L, Rui YF, Song XT. Left ventricular systolic function changes in hypertrophic cardiomyopathy patients detected by the strain of different myocardium layers and longitudinal rotation. BMC Cardiovasc Disord 2017; 17:214. [PMID: 28768478 PMCID: PMC5541417 DOI: 10.1186/s12872-017-0651-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Impairment of left ventricular (LV) longitudinal function has an important role in hypertrophic cardiomyopathy (HCM). This research investigated an association between the longitudinal strain of different myocardial layers, longitudinal rotation and the LV systolic function of HCM patients. METHODS The research was performed on 36 HCM patients and 36 healthy subjects. The peak systolic longitudinal strain of the subendocardial, midmyocardial, and subepicardial layers was measured using 2-dimensional speckle tracking echocardiography (2D-STE). The apical long-axis and 4- and 2- chamber views were acquired via 2D Doppler echocardiography. The curve of the longitudinal rotation was traced at 17 timepoints in the analysis of 2 cardiac cycles. RESULTS Compared with healthy subjects, in HCM patients regional LV peak systolic longitudinal strain was less, not only in hypertrophied LV myocardium, but also in non-hypertrophied myocardium. The rotational degrees of the midmyocardial-septal, apex, and lateral wall of HCM patients were significantly different from that of normal subjects, as follows. In HCM patients, clockwise longitudinal rotation was found. The interventricular septum thickness at end-diastole positively correlated with the peak longitudinal systolic strain of the subendocardial, the midmyocardial, and the subepicardial layers. The area under ROC curve values for subendocardial, midmyocardial and subepicardial layers in HCM patients were 0.923, 0.938, 0.948. CONCLUSION In HCM patients, the longitudinal function was damaged, even with normal LV ejection fraction. The peak longitudinal systolic strain of the subendocardial, midmyocardial, and subepicardial layers, and the longitudinal rotation detected by 2D-STE, are very sensitive predictors of systolic function in patients with HCM.
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Affiliation(s)
- Jun Huang
- Department of Echocardiography, ChangZhou No.2 People's Hospital Affiliated to NanJing Medical University, ChangZhou, 213003, China.
| | - Zi-Ning Yan
- Department of Echocardiography, ChangZhou No.2 People's Hospital Affiliated to NanJing Medical University, ChangZhou, 213003, China
| | - Li Fan
- Department of Echocardiography, ChangZhou No.2 People's Hospital Affiliated to NanJing Medical University, ChangZhou, 213003, China
| | - Yi-Fei Rui
- Department of Echocardiography, ChangZhou No.2 People's Hospital Affiliated to NanJing Medical University, ChangZhou, 213003, China
| | - Xiang-Ting Song
- Department of Echocardiography, ChangZhou No.2 People's Hospital Affiliated to NanJing Medical University, ChangZhou, 213003, China
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86
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Hindieh W, Chan R, Rakowski H. Complementary Role of Echocardiography and Cardiac Magnetic Resonance in Hypertrophic Cardiomyopathy. Curr Cardiol Rep 2017; 19:81. [DOI: 10.1007/s11886-017-0897-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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87
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Piras P, Torromeo C, Evangelista A, Gabriele S, Esposito G, Nardinocchi P, Teresi L, Madeo A, Schiariti M, Varano V, Puddu PE. Homeostatic Left Heart integration and disintegration links atrio-ventricular covariation's dyshomeostasis in Hypertrophic Cardiomyopathy. Sci Rep 2017; 7:6257. [PMID: 28740203 PMCID: PMC5524707 DOI: 10.1038/s41598-017-06189-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 06/07/2017] [Indexed: 12/29/2022] Open
Abstract
Left ventricle and left atrium are and have been practically always analyzed separately in common clinically and non-clinically oriented cardiovascular investigations. Both classic and speckle tracking echocardiographic data contributed to the knowledge about deformational impairments occurring in systo-diastolic differences. Recently new trajectory based approaches allowed a greater awareness about the entire left ventricle or left atrium revolution and on their deficiencies that take place in presence of hypertrophic cardiomyopathy. However, surprisingly, the concomitant function of the two left heart chambers has not been analyzed for their geometrical/mechanical relationship. For the first time we study here, by acquiring left ventricle and left atrial geometries on the same heartbeat, the trajectory attributes of the entire left heart treated as a whole shape and the shape covariation of its two subunits. We contrasted healthy subjects with patients affected by hypertrophic cardiomyopathy. We found impaired left heart trajectory mainly in terms of orientation and size. More importantly, we found profound differences in the direction of morphological covariation of left ventricle and left atrium. These findings open to new perspectives in pathophysiological evaluation of different diseases by allowing the appreciation of concomitant functioning of both left heart whole geometry and of its two chambers.
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Affiliation(s)
- Paolo Piras
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Sapienza - Università di Roma, Rome, Italy.,Dipartimento di Ingegneria Strutturale e Geotecnica, Sapienza - Università di Roma, Rome, Italy
| | - Concetta Torromeo
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Sapienza - Università di Roma, Rome, Italy
| | | | - Stefano Gabriele
- Dipartimento di Architettura, LaMS - Modeling & Simulation Lab, Università Roma Tre, Rome, Italy
| | - Giuseppe Esposito
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Sapienza - Università di Roma, Rome, Italy
| | - Paola Nardinocchi
- Dipartimento di Ingegneria Strutturale e Geotecnica, Sapienza - Università di Roma, Rome, Italy
| | - Luciano Teresi
- Dipartimento di Matematica e Fisica, LaMS - Modeling & Simulation Lab, Università Roma Tre, Rome, Italy
| | - Andrea Madeo
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Sapienza - Università di Roma, Rome, Italy
| | - Michele Schiariti
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Sapienza - Università di Roma, Rome, Italy
| | - Valerio Varano
- Dipartimento di Architettura, LaMS - Modeling & Simulation Lab, Università Roma Tre, Rome, Italy
| | - Paolo Emilio Puddu
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Sapienza - Università di Roma, Rome, Italy.
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Mazurkiewicz Ł, Ziółkowska L, Petryka J, Śpiewak M, Małek Ł, Kubik A, Marczak M, Misko J, Brzezińska-Rajszys G. Left-ventricular mechanics in children with hypertrophic cardiomyopathy. CMR study. Magn Reson Imaging 2017; 43:56-65. [PMID: 28688952 DOI: 10.1016/j.mri.2017.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/30/2017] [Accepted: 07/02/2017] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To assess the magnitude of myocardial displacement abnormalities and their alterations with the fibrosis, left-ventricular (LV) outflow tract obstruction (LVOTO) and hypertrophy in juveniles with hypertrophic cardiomyopathy (HCM). STUDY DESIGN Fifty-five children [age 12,5±4.6years, 38 (69,1%) males, 19 (34,5%) with LVOTO] with HCM and 20 controls underwent cardiovascular magnetic resonance. The LV feature tracking (FT) derived strain and strain rates were quantified. Results of FT analysis were compared between HCM subjects and controls and between children with and without LVOTO. RESULTS Children with HCM exhibited decreased strain in both hypertrophied and nonhypertrophied segments versus controls. LV global longitudinal strain (LVGLS) rate (-0.69±0.04 vs -0.91±0.05, p=0,04), LV circumferential strain (LVCR) rate (-0.98±0.09 vs -1.27±0.06, p=0,02), LV radial strain (LVR) (18,5±1.9 vs 27,4±1.4, p<0,01) and LVR rate (0,98±0.1 vs 1,53±0.08, p<0,01) were substantially compromised in subjects with LVOTO vs without. In multivariable regression all LV myocardial dynamics markers, except for LVCR, exhibited a significant association with the degree of LVOTO. LVCR rate (β=0,31, p=0,02) and LVR (β=-0.24, p=0,04) were related to LV mass and only LVCR rate (β=0,15, p=0,03) was associated with the amount of LV fibrosis. CONCLUSIONS The reduction of all indices of LV myocardial mechanics in juvenile HCM patients was global but particularly pronounced in hypertrophied segments of the LV. The majority of the LV strains and strain rates were substantially compromised in subjects with LVOTO compared to patients without the obstruction. Myocardial mechanics indices seemed to be related to the degree of LVOTO rather than either to mass or the amount of fibrosis.
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Affiliation(s)
- Łukasz Mazurkiewicz
- Department of Cardiomyopathies, CMR Unit, Institute of Cardiology, Warsaw, Poland.
| | - Lidia Ziółkowska
- Department of Pediatric Cardiology, The Children's Memorial Health Institute, Warsaw, Poland
| | - Joanna Petryka
- Department of Coronary and Structural Heart Diseases, CMR Unit, Institute of Cardiology, Warsaw, Poland
| | | | | | - Agata Kubik
- CMR Unit, Institute of Cardiology, Warsaw, Poland
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Hiremath P, Lawler PR, Ho JE, Correia AW, Abbasi SA, Kwong RY, Jerosch-Herold M, Ho CY, Cheng S. Ultrasonic Assessment of Myocardial Microstructure in Hypertrophic Cardiomyopathy Sarcomere Mutation Carriers With and Without Left Ventricular Hypertrophy. Circ Heart Fail 2017; 9:CIRCHEARTFAILURE.116.003026. [PMID: 27623770 DOI: 10.1161/circheartfailure.116.003026] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 08/10/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The noninvasive assessment of altered myocardium in patients with genetic mutations that are associated with hypertrophic cardiomyopathy (HCM) remains challenging. In this pilot study, we evaluated whether a novel echocardiography-based assessment of myocardial microstructure, the signal intensity coefficient (SIC), could detect tissue-level alterations in HCM sarcomere mutation carriers with and without left ventricular hypertrophy. METHODS AND RESULTS We studied 3 groups of genotyped individuals: sarcomere mutation carriers with left ventricular hypertrophy (clinical HCM; n=36), mutation carriers with normal left ventricular wall thickness (subclinical HCM; n=28), and healthy controls (n=10). We compared measurements of echocardiographic SIC with validated assessments of cardiac microstructural alteration, including cardiac magnetic resonance measures of interstitial fibrosis (extracellular volume fraction), as well as serum biomarkers (NTproBNP, hs-cTnI, and PICP). In age-, sex-, and familial relation-adjusted analyses, the SIC was quantitatively different across subjects with overt HCM, subclinical HCM, and healthy controls (P<0.001). Compared with controls, the SIC was 61% higher in overt HCM and 47% higher in subclinical HCM (P<0.001 for both). The SIC was significantly correlated with extracellular volume (r=0.72; P<0.01), with left ventricular mass and E' velocity (r=0.45, -0.60, respectively; P<0.01 for both), and with serum NTproBNP levels (r=0.36; P<0.001). CONCLUSIONS Our findings suggest that the SIC could serve as a noninvasive quantitative tool for assessing altered myocardial tissue characteristics in patients with genetic mutations associated with HCM. Further studies are needed to determine whether the SIC could be used to identify subclinical changes in patients at risk for HCM and to evaluate the effects of interventions.
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Affiliation(s)
- Pranoti Hiremath
- From the Cardiovascular Division, Department of Medicine (P.H., P.R.L., R.Y.K., C.Y.H., S.C.) and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston (J.E.H.); SessionM, Boston, MA (A.W.C.); and Division of Cardiology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (S.A.A.)
| | - Patrick R Lawler
- From the Cardiovascular Division, Department of Medicine (P.H., P.R.L., R.Y.K., C.Y.H., S.C.) and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston (J.E.H.); SessionM, Boston, MA (A.W.C.); and Division of Cardiology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (S.A.A.)
| | - Jennifer E Ho
- From the Cardiovascular Division, Department of Medicine (P.H., P.R.L., R.Y.K., C.Y.H., S.C.) and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston (J.E.H.); SessionM, Boston, MA (A.W.C.); and Division of Cardiology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (S.A.A.)
| | - Andrew W Correia
- From the Cardiovascular Division, Department of Medicine (P.H., P.R.L., R.Y.K., C.Y.H., S.C.) and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston (J.E.H.); SessionM, Boston, MA (A.W.C.); and Division of Cardiology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (S.A.A.)
| | - Siddique A Abbasi
- From the Cardiovascular Division, Department of Medicine (P.H., P.R.L., R.Y.K., C.Y.H., S.C.) and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston (J.E.H.); SessionM, Boston, MA (A.W.C.); and Division of Cardiology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (S.A.A.)
| | - Raymond Y Kwong
- From the Cardiovascular Division, Department of Medicine (P.H., P.R.L., R.Y.K., C.Y.H., S.C.) and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston (J.E.H.); SessionM, Boston, MA (A.W.C.); and Division of Cardiology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (S.A.A.)
| | - Michael Jerosch-Herold
- From the Cardiovascular Division, Department of Medicine (P.H., P.R.L., R.Y.K., C.Y.H., S.C.) and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston (J.E.H.); SessionM, Boston, MA (A.W.C.); and Division of Cardiology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (S.A.A.)
| | - Carolyn Y Ho
- From the Cardiovascular Division, Department of Medicine (P.H., P.R.L., R.Y.K., C.Y.H., S.C.) and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston (J.E.H.); SessionM, Boston, MA (A.W.C.); and Division of Cardiology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (S.A.A.).
| | - Susan Cheng
- From the Cardiovascular Division, Department of Medicine (P.H., P.R.L., R.Y.K., C.Y.H., S.C.) and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston (J.E.H.); SessionM, Boston, MA (A.W.C.); and Division of Cardiology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (S.A.A.).
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90
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Wu LM, An DAL, Yao QY, Ou YRZ, Lu Q, Jiang M, Xu JR. Hypertrophic cardiomyopathy and left ventricular hypertrophy in hypertensive heart disease with mildly reduced or preserved ejection fraction: insight from altered mechanics and native T1 mapping. Clin Radiol 2017; 72:835-843. [PMID: 28552325 DOI: 10.1016/j.crad.2017.04.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 01/19/2017] [Accepted: 04/24/2017] [Indexed: 01/19/2023]
Abstract
AIM To explore the relationship between extracellular volume (ECV), native T1, and systolic strain in hypertrophic cardiomyopathy (HCM) and hypertensive patients with left ventricular hypertrophy (HTN LVH) with mildly reduced or preserved ejection fraction. MATERIALS AND METHODS T1 mapping was performed in 45 patients with late gadolinium enhancement positive (LGE+) HCM (mean age, 53±6 years), 11 patients with LGE- (LGE-) HCM (mean age, 56±5 years), and 20 patients with HTN LVH (mean age, 55±6 years) on at 3 T magnetic resonance imaging (MRI) using the modified look-locker inversion-recovery (MOLLI) pulse sequence. Mean T1 value, ECV and circumferential strain parameters were determined for each patient. RESULTS Overall, the HCM patients had higher native T1 values (1242.92±68.94) and ECV (0.31±0.05) in comparison to those of the HTN LVH patients (1197±46.80, 0.27±0.04; p<0.05). In the subgroup analysis, the HCM LGE+ patients had the highest native T1 values among the three groups. The HCM LGE+ patients had higher ECV than the LGE- patients. HCM LGE- patients had higher ECV than HTN LVH patients (p<0.05). Peak systolic circumferential strain and early diastolic strain rates were reduced in the HCM LGE+ patients in comparison to the HCM LGE- and HTN LVH patients (p<0.05). Reduced peak systolic and early diastolic circumferential strain rates were associated with increased levels of ECV and native T1 values among all the patients. CONCLUSION HCM LGE+ patients had higher native T1 values, higher ECV, and an associated reduction in early diastolic strain rates and peak systolic circumferential strains when compared to the HCM LGE- and HTN LVH patients with mildly reduced or preserved ejection fraction.
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Affiliation(s)
- L-M Wu
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - D-A L An
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Q-Y Yao
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Y-R Z Ou
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Q Lu
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - M Jiang
- Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China.
| | - J-R Xu
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China.
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91
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Haland TF, Hasselberg NE, Almaas VM, Dejgaard LA, Saberniak J, Leren IS, Berge KE, Haugaa KH, Edvardsen T. The systolic paradox in hypertrophic cardiomyopathy. Open Heart 2017; 4:e000571. [PMID: 28674623 PMCID: PMC5471858 DOI: 10.1136/openhrt-2016-000571] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/08/2017] [Accepted: 03/21/2017] [Indexed: 01/04/2023] Open
Abstract
Objective We explored cardiac volumes and the effects on systolic function in hypertrophic cardiomyopathy (HCM) patients with left ventricular hypertrophy (HCM LVH+) and genotype-positive patients without left ventricular hypertrophy (HCM LVH−). Methods We included 180 HCM LVH+, 100 HCM LVH− patients and 80 healthy individuals. End-Diastolic Volume Index (EDVI), End-Systolic Volume Index (ESVI) and ejection fraction (EF) were assessed by echocardiography. Left ventricular (LV) global longitudinal strain (GLS) was measured by speckle tracking echocardiography. Results EDVI and ESVI were significantly smaller in HCM LVH+ compared with HCM LVH− patients (41±14 mL/m2 vs 49±13 mL/m2 and 16±7 mL/m2 vs 19±6 mL/m2, respectively, both p<0.001) and in healthy individuals (41±14 mL/m2 vs 57±14 mL/m2 and 16±7 mL/m2 vs 23±9 mL/m2, respectively, both p<0.001). HCM LVH− patients had significantly lower EDVI and ESVI compared with healthy individuals (49±13 mL/m2 vs 57±14 mL/m2 and 19±6 mL/m2 vs 23±9 mL/m2, both p<0.001). EF was similar (61%±7% vs 60%±8% vs 61%±6%, p=0.43) in the HCM LVH+, HCM LVH– and healthy individuals, despite significantly worse GLS in the HCM LVH+ (−16.4%±3.7% vs −21.3%±2.4% vs −22.3%±3.7%, p<0.001). GLS was worse in the HCM LVH− compared with healthy individuals in pairwise comparison (p=0.001). Decrease in ESVI was closely related to EF in HCM LVH+ and HCM LVH− (R=0.45, p<0.001 and R=0.43, p<0.001) as expected, but there was no relationship with GLS (R=0.02, p=0.77 and R=0.11, p=0.31). Increased maximal wall thickness (MWT) correlated significantly with worse GLS (R=0.58, p<0.001), but not with EF (R=0.018, p=0.30) in the HCM LVH+ patients. Conclusion HCM LVH+ had smaller cardiac volumes that could explain the preserved EF, despite worse GLS that was closely related to MWT. HCM LVH− had reduced cardiac volumes and subtle changes in GLS compared with healthy individuals, indicating a continuum of both volumetric and systolic changes present before increased MWT.
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Affiliation(s)
- Trine F Haland
- Department of Cardiology, Institute for Surgical Research and Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,University of Oslo, Norway
| | - Nina E Hasselberg
- Department of Cardiology, Institute for Surgical Research and Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,University of Oslo, Norway
| | - Vibeke Marie Almaas
- Department of Cardiology, Institute for Surgical Research and Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,University of Oslo, Norway
| | - Lars A Dejgaard
- Department of Cardiology, Institute for Surgical Research and Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,University of Oslo, Norway
| | - Jørg Saberniak
- Department of Cardiology, Institute for Surgical Research and Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,University of Oslo, Norway
| | - Ida S Leren
- Department of Cardiology, Institute for Surgical Research and Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,University of Oslo, Norway
| | - Knut Erik Berge
- Department of Medical Genetics, Unit for Cardiac and Cardiovascular Genetics, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Kristina H Haugaa
- Department of Cardiology, Institute for Surgical Research and Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,University of Oslo, Norway
| | - Thor Edvardsen
- Department of Cardiology, Institute for Surgical Research and Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,University of Oslo, Norway
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93
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Spalla I, Payne JR, Borgeat K, Pope A, Fuentes VL, Connolly DJ. Mitral Annular Plane Systolic Excursion and Tricuspid Annular Plane Systolic Excursion in Cats with Hypertrophic Cardiomyopathy. J Vet Intern Med 2017; 31:691-699. [PMID: 28370313 PMCID: PMC5435071 DOI: 10.1111/jvim.14697] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 01/03/2017] [Accepted: 02/23/2017] [Indexed: 11/29/2022] Open
Abstract
Background Left ventricular (LV) systolic dysfunction is associated with increased risk of death in cats with hypertrophic cardiomyopathy (HCM). Mitral and tricuspid annular plane systolic excursion (MAPSE and TAPSE, respectively) are measures of longitudinal systolic function and are reduced in human patients with HCM. Hypotheses Cats with HCM have lower MAPSE and TAPSE compared to control cats; lower MAPSE and TAPSE are associated with the presence of congestive heart failure (CHF) and reduced survival time. Animals 64 cats with HCM and 27 healthy cats. Forty‐five cats with HCM were not showing clinical signs, and 19 had CHF. Methods Retrospective study. Anatomic M‐mode from the left apical 4‐chamber view was used to record MAPSE from the free wall (MAPSE FW) and septum (MAPSE IVS) and TAPSE. Results Compared to controls, cats with HCM had lower MAPSE IVS (controls 5.2 [4.6–5.6] mm, asymptomatic HCM 4.7 [4.1–5.2] mm, HCM with CHF 2.6 [2.5–3.2] mm, P < .001), MAPSE FW (controls 5.9 [5.3–6.2] mm, asymptomatic HCM 4.7 [4.1–5.1] mm, HCM with CHF 2.8 [2.4–3.2] mm) and TAPSE (controls 8.6 [7.4–10.2] mm, asymptomatic HCM 7.2 [6.3–8.2] mm, HCM with CHF 4.6 [4.1–5.4] mm), with the lowest in the CHF group. Univariate survival analysis showed a shorter survival in cats displaying lower MAPSE IVS, MAPSE FW, and TAPSE. Conclusions and Clinical Importance MAPSE and TAPSE were lower in cats with HCM than in control cats and were lowest in CHF, suggesting that systolic longitudinal dysfunction is present in cats with HCM. MAPSE and TAPSE have potential prognostic significance.
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Affiliation(s)
- I Spalla
- Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, UK
| | - J R Payne
- Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, UK.,Highcroft Veterinary Referrals, Whitchurch, Bristol, UK
| | - K Borgeat
- Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, UK.,Highcroft Veterinary Referrals, Whitchurch, Bristol, UK
| | - A Pope
- Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, UK
| | - V Luis Fuentes
- Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, UK
| | - D J Connolly
- Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, UK
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94
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D'Andrea A, Radmilovic J, Ballo P, Mele D, Agricola E, Cameli M, Rossi A, Esposito R, Novo G, Mondillo S, Montisci R, Gallina S, Bossone E, Galderisi M. Left ventricular hypertrophy or storage disease? the incremental value of speckle tracking strain bull's-eye. Echocardiography 2017; 34:746-759. [DOI: 10.1111/echo.13506] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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95
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96
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Swoboda PP, McDiarmid AK, Erhayiem B, Law GR, Garg P, Broadbent DA, Ripley DP, Musa TA, Dobson LE, Foley JR, Fent GJ, Page SP, Greenwood JP, Plein S. Effect of cellular and extracellular pathology assessed by T1 mapping on regional contractile function in hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 2017; 19:16. [PMID: 28215181 PMCID: PMC5317053 DOI: 10.1186/s12968-017-0334-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 01/27/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Regional contractile dysfunction is a frequent finding in hypertrophic cardiomyopathy (HCM). We aimed to investigate the contribution of different tissue characteristics in HCM to regional contractile dysfunction. METHODS We prospectively recruited 50 patients with HCM who underwent cardiovascular magnetic resonance (CMR) studies at 3.0 T including cine imaging, T1 mapping and late gadolinium enhancement (LGE) imaging. For each segment of the American Heart Association model segment thickness, native T1, extracellular volume (ECV), presence of LGE and regional strain (by feature tracking and tissue tagging) were assessed. The relationship of segmental function, hypertrophy and tissue characteristics were determined using a mixed effects model, with random intercept for each patient. RESULTS Individually segment thickness, native T1, ECV and the presence of LGE all had significant associations with regional strain. The first multivariable model (segment thickness, LGE and ECV) demonstrated that all strain parameters were associated with segment thickness (P < 0.001 for all) but not ECV. LGE (Beta 2.603, P = 0.024) had a significant association with circumferential strain measured by tissue tagging. In a second multivariable model (segment thickness, LGE and native T1) all strain parameters were associated with both segment thickness (P < 0.001 for all) and native T1 (P < 0.001 for all) but not LGE. CONCLUSION Impairment of contractile function in HCM is predominantly associated with the degree of hypertrophy and native T1 but not markers of extracellular fibrosis (ECV or LGE). These findings suggest that impairment of contractility in HCM is mediated by mechanisms other than extracellular expansion that include cellular changes in structure and function. The cellular mechanisms leading to increased native T1 and its prognostic significance remain to be established.
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Affiliation(s)
- Peter P. Swoboda
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Adam K. McDiarmid
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Bara Erhayiem
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Graham R. Law
- Division of Epidemiology and Biostatistics, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Pankaj Garg
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - David A. Broadbent
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
- Department of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - David P. Ripley
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Tarique A. Musa
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Laura E. Dobson
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - James R. Foley
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Graham J. Fent
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Stephen P. Page
- Inherited Cardiovascular Conditions Service, Leeds General Infirmary, Leeds, LS1 3EX UK
| | - John P. Greenwood
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT UK
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97
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Moon J, Lee CJ, Lee SH, Kang SM, Choi D, Yoo TH, Park S. The Impact of Diabetes Mellitus on Vascular Biomarkers in Patients with End-Stage Renal Disease. Yonsei Med J 2017; 58:75-81. [PMID: 27873498 PMCID: PMC5122655 DOI: 10.3349/ymj.2017.58.1.75] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 07/31/2016] [Accepted: 08/16/2016] [Indexed: 01/10/2023] Open
Abstract
PURPOSE Diabetes mellitus (DM) is the most common cause of end-stage renal disease (ESRD) and an important risk factor for cardiovascular (CV) disease. We investigated the impact of DM on subclinical CV damage by comprehensive screening protocol in ESRD patients. MATERIALS AND METHODS Echocardiography, coronary computed tomography angiogram, 24-h ambulatory blood pressure monitoring, and central blood pressure with pulse wave velocity (PWV) were performed in 91 ESRD patients from the Cardiovascular and Metabolic disease Etiology Research Center-HIgh risk cohort. RESULTS The DM group (n=38) had higher systolic blood pressure than the non-DM group (n=53), however, other clinical CV risk factors were not different between two groups. Central aortic systolic pressure (148.7±29.8 mm Hg vs. 133.7±27.0 mm Hg, p= 0.014), PWV (12.1±2.7 m/s vs. 9.4±2.1 m/s, p<0.001), and early mitral inflow to early mitral annulus velocity (16.7±6.4 vs. 13.7±5.9, p=0.026) were higher in the DM group. Although the prevalence of coronary artery disease (CAD) was not different between the DM and the non-DM group (95% vs. 84.4%, p=0.471), the severity of CAD was higher in the DM group (p=0.01). In multivariate regression analysis, DM was an independent determinant for central systolic pressure (p=0.011), PWV (p<0.001) and the prevalence of CAD (p=0.046). CONCLUSION Diabetic ESRD patients have higher central systolic pressure and more advanced arteriosclerosis than the non-DM control group. These findings suggest that screening for subclinical CV damage may be helpful for diabetic ESRD patients.
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Affiliation(s)
- Jeonggeun Moon
- Cardiology Division, Department of Internal Medicine, Gachon University of Medicine and Science, Incheon, Korea
| | - Chan Joo Lee
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hak Lee
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Min Kang
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Hyun Yoo
- Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
| | - Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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98
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Schouver ED, Moceri P, Doyen D, Tieulie N, Queyrel V, Baudouy D, Cerboni P, Gibelin P, Leroy S, Fuzibet JG, Ferrari E. Early detection of cardiac involvement in sarcoidosis with 2-dimensional speckle-tracking echocardiography. Int J Cardiol 2016; 227:711-716. [PMID: 27836307 DOI: 10.1016/j.ijcard.2016.10.073] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/27/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND/OBJECTIVES Cardiac sarcoidosis (CS) is associated with high morbidity and sudden death. The absence of specific symptoms and lack of diagnostic gold standard technique is challenging. New imaging methods could improve the diagnosis of CS. The aim of our study was to assess the role of left ventricular (LV) longitudinal and circumferential strain as estimated by 2D speckle-tracking imaging in patients with diagnosed sarcoidosis without cardiac involvement according to the current guidelines. We investigated the prevalence of LV strain impairment in this population and assessed its relationship with clinical outcomes, composite of mortality, heart failure, arrhythmia and/or secondarily development of CS and cardiac device implantation. METHODS AND RESULTS We performed a prospective case-control longitudinal study including 35 patients with diagnosed sarcoidosis and normal cardiac function as assessed by standard transthoracic echocardiography and 35 healthy age- and gender-matched controls. All patients underwent a comprehensive echocardiographic study. Mean age of patients was 47.9±14.8years old (22 women). Compared with controls, global LV longitudinal strain (LV GLS) was reduced in sarcoidosis patients: (-17.2±3.1 vs -21.3±1.5%, p<0.0001). Circumferential LV strain was preserved in patients compared to controls (-19.9±-4.3% vs -21.3±1.5%, p=0.12). Impaired LV GLS was significantly associated with clinical outcomes (HR 1.56; [1.16-2.11], p<0.01) on univariate analysis. CONCLUSION Speckle-tracking echocardiography revealed decreased longitudinal LV strain in sarcoidosis patients that was associated with outcomes. LV GLS may represent an early marker of myocardial involvement in sarcoidosis patients that needs to be studied further.
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Affiliation(s)
| | - Pamela Moceri
- Cardiology Department, Hôpital Pasteur, CHU de Nice, Nice, France.
| | - Denis Doyen
- Medical Intensive Care Unit, Hôpital L'Archet, CHU de Nice, Nice, France
| | - Nathalie Tieulie
- Internal medicine Department, Hôpital L'Archet, CHU de Nice, Nice, France
| | - Viviane Queyrel
- Internal medicine Department, Hôpital L'Archet, CHU de Nice, Nice, France
| | - Delphine Baudouy
- Cardiology Department, Hôpital Pasteur, CHU de Nice, Nice, France
| | - Pierre Cerboni
- Cardiology Department, Hôpital Pasteur, CHU de Nice, Nice, France
| | - Pierre Gibelin
- Cardiology Department, Hôpital Pasteur, CHU de Nice, Nice, France
| | - Sylvie Leroy
- Respiratory medicine Department, Hôpital Pasteur, CHU de Nice, Nice, France
| | | | - Emile Ferrari
- Cardiology Department, Hôpital Pasteur, CHU de Nice, Nice, France
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99
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Characteristic systolic waveform of left ventricular longitudinal strain rate in patients with hypertrophic cardiomyopathy. Heart Vessels 2016; 32:591-599. [PMID: 27757525 DOI: 10.1007/s00380-016-0906-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 10/14/2016] [Indexed: 01/19/2023]
Abstract
We analyzed the waveform of systolic strain and strain-rate curves to find a characteristic left ventricular (LV) myocardial contraction pattern in patients with hypertrophic cardiomyopathy (HCM), and evaluated the utility of these parameters for the differentiation of HCM and LV hypertrophy secondary to hypertension (HT). From global strain and strain-rate curves in the longitudinal and circumferential directions, the time from mitral valve closure to the peak strains (T-LS and T-CS, respectively) and the peak systolic strain rates (T-LSSR and T-CSSR, respectively) were measured in 34 patients with HCM, 30 patients with HT, and 25 control subjects. The systolic strain-rate waveform was classified into 3 patterns ("V", "W", and "√" pattern). In the HCM group, T-LS was prolonged, but T-LSSR was shortened; consequently, T-LSSR/T-LS ratio was distinctly lower than in the HT and control groups. The "√" pattern of longitudinal strain-rate waveform was more frequently seen in the HCM group (74 %) than in the control (4 %) and HT (20 %) groups. Similar but less distinct results were obtained in the circumferential direction. To differentiate HCM from HT, the sensitivity and specificity of the T-LSSR/T-LS ratio <0.34 and the "√"-shaped longitudinal strain-rate waveform were 85 and 63 %, and 74 and 80 %, respectively. In conclusion, in patients with HCM, a reduced T-LSSR/T-LS ratio and a characteristic "√"-shaped waveform of LV systolic strain rate was seen, especially in the longitudinal direction. The timing and waveform analyses of systolic strain rate may be useful to distinguish between HCM and HT.
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100
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Sen-Chowdhry S, Jacoby D, Moon JC, McKenna WJ. Update on hypertrophic cardiomyopathy and a guide to the guidelines. Nat Rev Cardiol 2016; 13:651-675. [PMID: 27681577 DOI: 10.1038/nrcardio.2016.140] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiovascular disorder, affecting 1 in 500 individuals worldwide. Existing epidemiological studies might have underestimated the prevalence of HCM, however, owing to limited inclusion of individuals with early, incomplete phenotypic expression. Clinical manifestations of HCM include diastolic dysfunction, left ventricular outflow tract obstruction, ischaemia, atrial fibrillation, abnormal vascular responses and, in 5% of patients, progression to a 'burnt-out' phase characterized by systolic impairment. Disease-related mortality is most often attributable to sudden cardiac death, heart failure, and embolic stroke. The majority of individuals with HCM, however, have normal or near-normal life expectancy, owing in part to contemporary management strategies including family screening, risk stratification, thromboembolic prophylaxis, and implantation of cardioverter-defibrillators. The clinical guidelines for HCM issued by the ACC Foundation/AHA and the ESC facilitate evaluation and management of the disease. In this Review, we aim to assist clinicians in navigating the guidelines by highlighting important updates, current gaps in knowledge, differences in the recommendations, and challenges in implementing them, including aids and pitfalls in clinical and pathological evaluation. We also discuss the advances in genetics, imaging, and molecular research that will underpin future developments in diagnosis and therapy for HCM.
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Affiliation(s)
- Srijita Sen-Chowdhry
- Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK.,Department of Epidemiology, Imperial College, St Mary's Campus, Norfolk Place, London W2 1NY, UK
| | - Daniel Jacoby
- Section of Cardiovascular Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520, USA
| | - James C Moon
- Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK.,Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - William J McKenna
- Heart Hospital, Hamad Medical Corporation, Al Rayyan Road, Doha, Qatar
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