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Koyuncu A, Yildiz C, Oflar E, Mavi B, Ertugrul AS, Ocal L, Gürsoy MO, Kahveci G. Evaluation of the prognostic value of papillary muscle-free strain in patients with hypertrophic cardiomyopathy. Echocardiography 2024; 41:e15882. [PMID: 38979721 DOI: 10.1111/echo.15882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/10/2024] [Accepted: 06/21/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND The prognosis of hypertrophic cardiomyopathy (HCM) varies from mild disease with a normal life expectancy to heart failure and sudden cardiac death (SCD). The identification of patients who are at high risk for SCD remains challenging. AIMS In this study, we evaluated the prognostic value of papillary muscle-free strain in HCM patients. METHODS AND RESULTS Seventy-nine patients with a diagnosis of HCM were included in this study. Patients were divided into low/intermediate-risk (n = 57) and high-risk (n = 22) groups. Two-dimensional (2-D) echocardiography and strain imaging were performed for each patient. The mean age of the study population was 53.85 ± 15.88 years; 47 (59.5%) of them were male. During a mean follow-up duration of 74.45 ± 17.03 months, 12 patients died. A comparison of the low-intermediate and high-SCD risk groups revealed that patients in the high-SCD risk group had greater maximal wall thickness, interventricular septum thickness, posterior wall thickness, and left ventricular mass index (LVMI) and lower (less negative) global longitudinal, anterolateral papillary muscle (ALPM) and posteromedial papillary muscle (PMPM) free strain. Additionally, a history of syncope and ICD implantation were found to be more common in patients with high SCD risk scores. The SCD risk score was positively correlated with the global longitudinal strain, ALPM-free strain, and PMPM-free strain (r = .528, r = .658, and r = .600, respectively; p < .001 for all). Our results showed that the LVMI, presence of syncope, global longitudinal strain, and ALPM-free strain were predictors of death. CONCLUSIONS Decreased papillary muscle-free strain values might have prognostic value in patients with HCM.
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Affiliation(s)
- Atilla Koyuncu
- Department of Cardiology, Bakırkoy Dr Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Cennet Yildiz
- Department of Cardiology, Bakırkoy Dr Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Ersan Oflar
- Department of Cardiology, Bakırkoy Dr Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Busra Mavi
- Department of Cardiology, Bakırkoy Dr Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Abdulcelil Sait Ertugrul
- Department of Cardiology, Bakırkoy Dr Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Lutfi Ocal
- Department of Cardiology, Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Mustafa Ozan Gürsoy
- Department of Cardiology, Izmir Ataturk Education and Research Hospital, Izmir, Turkey
| | - Gokhan Kahveci
- Department of Cardiology, Istinye University, Liv Hospital, Istanbul, Turkey
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Moura B, Aimo A, Al-Mohammad A, Keramida K, Ben Gal T, Dorbala S, Todiere G, Cameli M, Barison A, Bayes-Genis A, von Bardeleben RS, Bucciarelli-Ducci C, Delgado V, Mordi IR, Seferovic P, Savarese G, Čelutkienė J, Rapezzi C, Emdin M, Coats A, Metra M, Rosano G. Diagnosis and management of patients with left ventricular hypertrophy: Role of multimodality cardiac imaging. A scientific statement of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2023; 25:1493-1506. [PMID: 37581253 DOI: 10.1002/ejhf.2997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/28/2023] [Accepted: 08/09/2023] [Indexed: 08/16/2023] Open
Abstract
Left ventricular (LV) hypertrophy consists in an increased LV wall thickness. LV hypertrophy can be either secondary, in response to pressure or volume overload, or primary, i.e. not explained solely by abnormal loading conditions. Primary LV hypertrophy may be due to gene mutations or to the deposition or storage of abnormal substances in the extracellular spaces or within the cardiomyocytes (more appropriately defined as pseudohypertrophy). LV hypertrophy is often a precursor to subsequent development of heart failure. Cardiovascular imaging plays a key role in the assessment of LV hypertrophy. Echocardiography, the first-line imaging technique, allows a comprehensive assessment of LV systolic and diastolic function. Cardiovascular magnetic resonance provides added value as it measures accurately LV and right ventricular volumes and mass and characterizes myocardial tissue properties, which may provide important clues to the final diagnosis. Additionally, scintigraphy with bone tracers is included in the diagnostic algorithm of cardiac amyloidosis. Once the diagnosis is established, imaging findings may help predict future disease evolution and inform therapy and follow-up. This consensus document by the Heart Failure Association of the European Society of Cardiology provides an overview of the role of different cardiac imaging techniques for the differential diagnosis and management of patients with LV hypertrophy.
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Affiliation(s)
- Brenda Moura
- Faculty of Medicine, University of Porto, Porto, Portugal
- Cardiology Department, Porto Armed Forces Hospital, Porto, Portugal
| | - Alberto Aimo
- Scuola Superiore Sant'Anna, Pisa, Italy
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Abdallah Al-Mohammad
- South Yorkshire Cardiothoracic Centre (Northern General Hospital), Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Kalliopi Keramida
- Cardiology Department, General Anti-Cancer, Oncological Hospital Agios Savvas, Athens, Greece
| | - Tuvia Ben Gal
- Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharmila Dorbala
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Giancarlo Todiere
- Scuola Superiore Sant'Anna, Pisa, Italy
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Matteo Cameli
- Cardiology Division, University Hospital of Siena, Siena, Italy
| | | | - Antoni Bayes-Genis
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBERCV, Carlos III Institute of Health, Madrid, Spain
| | | | | | - Victoria Delgado
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Ify R Mordi
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Petar Seferovic
- Serbian Academy of Sciences and Arts, Belgrade, Serbia
- University of Belgrade Faculty of Medicine, Belgrade, Serbia
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Heart and Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Jelena Čelutkienė
- Vilnius University, Faculty of Medicine, Vilnius, Lithuania
- State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Claudio Rapezzi
- Cardiology Centre, University of Ferrara, Ferrara, Italy
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Michele Emdin
- Faculty of Medicine, University of Porto, Porto, Portugal
- Cardiology Department, Porto Armed Forces Hospital, Porto, Portugal
| | | | - Marco Metra
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Heydari B, Satriano A, Jerosch-Herold M, Kolm P, Kim DY, Cheng K, Choi YL, Antiochos P, White JA, Mahmod M, Chan K, Raman B, Desai MY, Ho CY, Dolman SF, Desvigne-Nickens P, Maron MS, Friedrich MG, Schulz-Menger J, Piechnik SK, Appelbaum E, Weintraub WS, Neubauer S, Kramer CM, Kwong RY. 3-Dimensional Strain Analysis of Hypertrophic Cardiomyopathy: Insights From the NHLBI International HCM Registry. JACC Cardiovasc Imaging 2023; 16:478-491. [PMID: 36648040 PMCID: PMC10802851 DOI: 10.1016/j.jcmg.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 10/04/2022] [Accepted: 10/13/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Abnormal global longitudinal strain (GLS) has been independently associated with adverse cardiac outcomes in both obstructive and nonobstructive hypertrophic cardiomyopathy. OBJECTIVES The goal of this study was to understand predictors of abnormal GLS from baseline data from the National Heart, Lung, and Blood Institute (NHLBI) Hypertrophic Cardiomyopathy Registry (HCMR). METHODS The study evaluated comprehensive 3-dimensional left ventricular myocardial strain from cine cardiac magnetic resonance in 2,311 patients from HCMR using in-house validated feature-tracking software. These data were correlated with other imaging markers, serum biomarkers, and demographic variables. RESULTS Abnormal median GLS (> -11.0%) was associated with higher left ventricular (LV) mass index (93.8 ± 29.2 g/m2 vs 75.1 ± 19.7 g/m2; P < 0.0001) and maximal wall thickness (21.7 ± 5.2 mm vs 19.3 ± 4.1 mm; P < 0.0001), lower left (62% ± 9% vs 66% ± 7%; P < 0.0001) and right (68% ± 11% vs 69% ± 10%; P < 0.01) ventricular ejection fractions, lower left atrial emptying functions (P < 0.0001 for all), and higher presence and myocardial extent of late gadolinium enhancement (6 SD and visual quantification; P < 0.0001 for both). Elastic net regression showed that adjusted predictors of GLS included female sex, Black race, history of syncope, presence of systolic anterior motion of the mitral valve, reverse curvature and apical morphologies, LV ejection fraction, LV mass index, and both presence/extent of late gadolinium enhancement and baseline N-terminal pro-B-type natriuretic peptide and troponin levels. CONCLUSIONS Abnormal strain in hypertrophic cardiomyopathy is associated with other imaging and serum biomarkers of increased risk. Further follow-up of the HCMR cohort is needed to understand the independent relationship between LV strain and adverse cardiac outcomes in hypertrophic cardiomyopathy.
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Affiliation(s)
- Bobak Heydari
- Stephenson Cardiac Imaging Center, Department of Cardiac Sciences, University of Calgary, Calgary, Canada
| | - Alessandro Satriano
- Stephenson Cardiac Imaging Center, Department of Cardiac Sciences, University of Calgary, Calgary, Canada
| | | | - Paul Kolm
- MedStar Heart and Vascular Institute, Washington, DC, USA
| | - Dong-Yun Kim
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Kathleen Cheng
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Yuna L Choi
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - James A White
- Stephenson Cardiac Imaging Center, Department of Cardiac Sciences, University of Calgary, Calgary, Canada
| | - Masliza Mahmod
- Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Kenneth Chan
- Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Betty Raman
- Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Carolyn Y Ho
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Martin S Maron
- Lahey Hospital & Medical Center, Boston, Massachusetts, USA
| | | | - Jeanette Schulz-Menger
- Charité Experimental Clinical Research Center and Helios Clinics Berlin-Buch, Berlin, Germany
| | - Stefan K Piechnik
- Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | | | | | - Stefan Neubauer
- Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Christopher M Kramer
- Cardiovascular Division, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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Yang Y, Wu D, Wang H, Wang Y. Prognostic value of global longitudinal strain in hypertrophic cardiomyopathy: A systematic review and meta-analysis. Clin Cardiol 2022; 45:1184-1191. [PMID: 36177652 DOI: 10.1002/clc.23928] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/06/2022] [Accepted: 09/15/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND As previously reported, impairment of left ventricular global longitudinal strain (LVGLS) is associated with myocardial fibrosis, arrhythmias, and heart failure in hypertrophic cardiomyopathy (HCM) patients. HYPOTHESIS This study aimed to estimate the association between LVGLS measured by echocardiography and major adverse cardiovascular events (MACE) in patients with HCM. METHODS Pubmed, Embase, Scopus, and Cochrane Library databases were systematically searched for evaluating the difference of LVGLS between MACE and non-MACE and the relevance of LVGLS and MACE in HCM patients, mean difference (MD), and pooled hazard ratios (HR) with 95% confidence interval (CI) were calculated. Publication bias was detected by funnel plots and Egger's test, and trim-and-fill analysis was employed when publication bias existed. RESULTS A total of 13 studies reporting 2441 HCM patients were included in this meta-analysis. Absolute value of LVGLS was lower in the group of HCM with MACE (MD = 2.74, 95% CI: 2.50-2.99, p < .001; I2 = 0, p = .48). In the pooled unadjusted model, LVGLS was related to MACE (HR = 1.14, 95% CI: 1.06-1.22, p < .05, I2 = 58.4%, p < .01) and there is a mild heterogeneity, and sensitivity analysis showed stable results. In the pooled adjusted model, LVGLS was related to MACE (HR = 1.12, 95% CI: 1.08-1.16, p < .05; I2 = 0%, p = .442). Egger's tests showed publication bias, and trim-and-fill analysis was applied, with final results similar to the previous and still statistically significant. CONCLUSION The meta-analysis suggested that impaired LVGLS was associated with poor prognosis in HCM patients.
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Affiliation(s)
- Ying Yang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Dong Wu
- Department of Radiology, The First Bethune Hospital of Jilin University, Changchun, Jilin, China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Yanting Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
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Commentary: Seeing through the fog: Longitudinal strain as a predictor of survival after septal myectomy. J Thorac Cardiovasc Surg 2021:S0022-5223(21)01412-4. [PMID: 34666908 DOI: 10.1016/j.jtcvs.2021.09.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 11/22/2022]
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