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Boban M, Pesa V, Antic Kauzlaric H, Brusich S, Rotim A, Madzar T, Zulj M, Vcev A. Ventricular diastolic dimension over maximal myocardial thickness is robust landmark of systolic impairment in patients with hypertrophic cardiomyopathy. Med Sci Monit 2018; 24:1880-1886. [PMID: 29602944 PMCID: PMC5892461 DOI: 10.12659/msm.906111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background The effects of focal hypertrophy on geometry of the left ventricle and systolic function have not been studied in patients with hypertrophic cardiomyopathy (HCM), despite the fact that the former is the most prominent disease characteristic. The aim of our study was to analyze systolic function over ventricle geometry, generating a functional index made from left ventricle end diastolic dimension (LVEDD) divided by end diastolic thickness of the region with maximal extent of hypertrophy and interventricular septum. Material/Methods Our hospital database of cardiac magnetic resonance was screened for HCM. Geometric functional index (GFI) was calculated for LVEDD over maximal end diastolic thickness (MaxEDT) giving GFI-M, while LVEDD over interventricular septum was expressed as GFI-I. There were 55 consecutive patients with HCM. Results There were 43 males (78.2%) and 12 females (21.8%). The mean age was 52.3±16.7 years (range: 15.5–76.4 years). A significant difference of GFI was found for preserved versus impaired systolic function of the left ventricle (preserved systolic function); GFI-M 2.28±0.60 versus 3.66±0.50 (p<0.001), and GFI-I 2.75±0.88 versus 3.81±0.87 (p<0.001), respectively. Diagnostic value was tested using receiver operating curve (ROC) analyzes, with GFI-M area under curve (AUC)=0.959 (95% CI: 0.868–0.994); (p<0.001) and GFI-I-AUC=0.847 (0.724–0.930); (p<0.001). GFI-M was superior to GFI-I for appraisal of left ventricle systolic dysfunction in HCM; ΔAUC=0.112 (0.018–0.207); (p=0.020). Conclusions GFI is a simple tool, with high sensitivity and specificity for detecting impairment of systolic function in patients with HCM. Further studies would be necessary to investigate its clinical and prognostic impacts, as well as reproducibility with prospective validation.
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Affiliation(s)
- Marko Boban
- Department of Cardiology, University Hospital "Thalassotherapia Opatija", Medical Faculty University of Rijeka, Rijeka, Croatia.,Department of Internal Medicine, Medical Faculty "J.J. Strossmayer" University of Osijek, Osijek, Croatia
| | - Vladimir Pesa
- Department of Cardiology, University Hospital "Thalassotherapia Opatija", Medical Faculty University of Rijeka, Rijeka, Croatia
| | - Helena Antic Kauzlaric
- Department of Cardiology, University Hospital "Thalassotherapia Opatija", Medical Faculty University of Rijeka, Rijeka, Croatia
| | - Sandro Brusich
- Department of Cardiology, University Hospital Centre Rijeka, Medical Faculty University of Rijeka, Rijeka, Croatia
| | - Ante Rotim
- Department of Cardiology, University Hospital "Thalassotherapia Opatija", Medical Faculty University of Rijeka, Rijeka, Croatia
| | - Tomislav Madzar
- Department of Internal Medicine, Medical Faculty "J.J. Strossmayer" University of Osijek, Osijek, Croatia
| | - Marinko Zulj
- Department of Internal Medicine, Medical Faculty "J.J. Strossmayer" University of Osijekk, Osijek, Croatia
| | - Aleksandar Vcev
- Department of Internal Medicine, Medical Faculty "J.J. Strossmayer" University of Osijek, Osijek, Croatia
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Rodrigues JCL, Rohan S, Dastidar AG, Trickey A, Szantho G, Ratcliffe LEK, Burchell AE, Hart EC, Bucciarelli-Ducci C, Hamilton MCK, Nightingale AK, Paton JFR, Manghat NE, MacIver DH. The Relationship Between Left Ventricular Wall Thickness, Myocardial Shortening, and Ejection Fraction in Hypertensive Heart Disease: Insights From Cardiac Magnetic Resonance Imaging. J Clin Hypertens (Greenwich) 2016; 18:1119-1127. [PMID: 27316563 PMCID: PMC8032154 DOI: 10.1111/jch.12849] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/11/2016] [Accepted: 04/13/2016] [Indexed: 12/13/2022]
Abstract
Hypertensive heart disease is often associated with a preserved left ventricular ejection fraction despite impaired myocardial shortening. The authors investigated this paradox in 55 hypertensive patients (52±13 years, 58% male) and 32 age- and sex-matched normotensive control patients (49±11 years, 56% male) who underwent cardiac magnetic resonance imaging at 1.5T. Long-axis shortening (R=0.62), midwall fractional shortening (R=0.68), and radial strain (R=0.48) all decreased (P<.001) as end-diastolic wall thickness increased. However, absolute wall thickening (defined as end-systolic minus end-diastolic wall thickness) was maintained, despite the reduced myocardial shortening. Absolute wall thickening correlated with ejection fraction (R=0.70, P<.0001). In multiple linear regression analysis, increasing wall thickness by 1 mm independently increased ejection fraction by 3.43 percentage points (adjusted β-coefficient: 3.43 [2.60-4.26], P<.0001). Increasing end-diastolic wall thickness augments ejection fraction through preservation of absolute wall thickening. Left ventricular ejection fraction should not be used in patients with hypertensive heart disease without correction for degree of hypertrophy.
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Affiliation(s)
- Jonathan C L Rodrigues
- NIHR Bristol Cardiovascular Biomedical Research Unit, Cardiac Magnetic Resonance Department Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- School of Physiology, Pharmacology and Neuroscience, Faculty of Biomedical Sciences, University of Bristol, Bristol, UK
| | - Stephen Rohan
- Medical School, Faculty of Medicine and Dentistry, University of Bristol, Bristol, UK
| | - Amardeep Ghosh Dastidar
- NIHR Bristol Cardiovascular Biomedical Research Unit, Cardiac Magnetic Resonance Department Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Adam Trickey
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Gergely Szantho
- NIHR Bristol Cardiovascular Biomedical Research Unit, Cardiac Magnetic Resonance Department Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Laura E K Ratcliffe
- CardioNomics Research Group, Clinical Research and Imaging Centre, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Amy E Burchell
- CardioNomics Research Group, Clinical Research and Imaging Centre, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Emma C Hart
- School of Physiology, Pharmacology and Neuroscience, Faculty of Biomedical Sciences, University of Bristol, Bristol, UK
- CardioNomics Research Group, Clinical Research and Imaging Centre, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Chiara Bucciarelli-Ducci
- NIHR Bristol Cardiovascular Biomedical Research Unit, Cardiac Magnetic Resonance Department Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Mark C K Hamilton
- NIHR Bristol Cardiovascular Biomedical Research Unit, Cardiac Magnetic Resonance Department Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Angus K Nightingale
- CardioNomics Research Group, Clinical Research and Imaging Centre, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Julian F R Paton
- School of Physiology, Pharmacology and Neuroscience, Faculty of Biomedical Sciences, University of Bristol, Bristol, UK
- CardioNomics Research Group, Clinical Research and Imaging Centre, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Nathan E Manghat
- NIHR Bristol Cardiovascular Biomedical Research Unit, Cardiac Magnetic Resonance Department Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - David H MacIver
- Medical School, Faculty of Medicine and Dentistry, University of Bristol, Bristol, UK.
- Department of Cardiology, Musgrove Park Hospital, Taunton, UK.
- Biological Physics Group School of Physics & Astronomy, University of Manchester, Manchester, UK.
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3
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Evaluation of left ventricular structure and function by three-dimensional echocardiography. Curr Opin Crit Care 2013; 19:387-96. [DOI: 10.1097/mcc.0b013e328364d75e] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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4
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Kauer F, van Dalen BM, Soliman OII, van der Zwaan HB, Vletter WB, Schinkel AFL, ten Cate FJ, Geleijnse ML. Regional left ventricular rotation and back-rotation in patients with reverse septal curvature hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2012; 14:435-42. [DOI: 10.1093/ehjci/jes163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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5
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Saito M, Okayama H, Yoshii T, Hiasa G, Sumimoto T, Inaba S, Nishimura K, Inoue K, Ogimoto A, Ohtsuka T, Funada JI, Shigematsu Y, Higaki J. The differences in left ventricular torsional behavior between patients with hypertrophic cardiomyopathy and hypertensive heart disease. Int J Cardiol 2011; 150:301-6. [DOI: 10.1016/j.ijcard.2010.04.040] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Revised: 02/26/2010] [Accepted: 04/15/2010] [Indexed: 01/20/2023]
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Papadopoulos DP, Papademetriou V. Hypertrophic and hypertensive hypertrophic cardiomyopathy--a true association? Angiology 2009; 61:92-9. [PMID: 19240104 DOI: 10.1177/0003319709331391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The cardiomyopathies were previously defined as ''heart muscle diseases of unknown cause'' and were differentiated from specific heart muscle disease with known cause. With increasing understanding of etiology and pathogenesis, the difference between cardiomyopathy and specific heart muscle disease has become indistinct. The term specific cardiomyopathies are used to describe heart diseases that are associated with specific cardiac or systemic disorders. These were previously defined as specific heart muscle diseases. They included ischemic cardiomyopathy, valvular cardiomyopathy, hypertensive cardiomyopathy, inflammatory cardiomyopathy, metabolic cardiomyopathy, general system disease, muscular dystrophies, sensitivity and toxic reactions, and peripartal cardiomyopathy. The cardiomyopathies are therefore classified by the dominant pathophysiology or, if possible, by etiological/pathogenetic factors. Topol in 1985 described a syndrome called hypertensive hypertrophic cardiomyopathy that included severe concentric cardiac hypertrophy, a small left ventricular cavity, and supernormal indexes of systolic function without concurrent medical illness or ischemic heart disease. The aim of this review was to highlighted this syndrome from pathophysiological, clinical, diagnostical view and clear all the possible correlations with genetic, inflammatory, and other markers.
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Abramov D, Helmke S, Rumbarger LEK, King DL, Maurer MS. Overestimation of left ventricular mass and misclassification of ventricular geometry in heart failure patients by two-dimensional echocardiography in comparison with three-dimensional echocardiography. Echocardiography 2009; 27:223-9. [PMID: 20070363 DOI: 10.1111/j.1540-8175.2009.01004.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Accurate assessment of left ventricular hypertrophy (LVH) and ventricular geometry is important, especially in patients with heart failure (HF). The aim of this study was to compare the assessment of ventricular size and geometry by 2D and 3D echocardiography in normotensive controls and among HF patients with a normal and a reduced ejection fraction. METHODS One hundred eleven patients, including 42 normotensive patients without cardiac disease, 41 hypertensive patients with HF and a normal ejection fraction (HFNEF), and 28 patients with HF and a low ejection fraction (HFLEF), underwent 2DE and freehand 3DE. The differences between 2DE and 3DE derived LVM were evaluated by use of a Bland-Altman plot. Differences in classification of geometric types among the cohort between 2DE and 3DE were determined. RESULTS Two-dimensional echocardiography overestimated ventricular mass compared to 3D echocardiography (3DE) among normal (166 +/- 36 vs. 145 +/- 20 gm, P = 0.002), HFNEF (258 +/- 108 vs. 175 +/- 47gm, P < 0.001), and HFLEF (444 +/- 136 vs. 259 +/- 77 gm, P < 0.001) patients. The overestimation of mass by 2DE increased in patients with larger ventricular size. The use of 3DE to assess ventricular geometry resulted in reclassification of ventricular geometric patterns in 76% of patients with HFNEF and in 21% of patients with HFLEF. CONCLUSION 2DE overestimates ventricular mass when compared to 3DE among patients with heart failure with both normal and low ejection fractions and leads to significant misclassification of ventricular geometry in many heart failure patients.
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Affiliation(s)
- Dmitry Abramov
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York 10034, USA
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8
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Minoshima M, Noda A, Nishizawa T, Hara Y, Sugiura M, Iino S, Nagata K, Koike Y, Murohara T. Endomyocardial Radial Strain Imaging and Left Ventricular Relaxation Abnormalities in Patients With Hypertrophic Cardiomyopathy or Hypertensive Left Ventricular Hypertrophy. Circ J 2009; 73:2294-9. [DOI: 10.1253/circj.cj-08-0879] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Akiko Noda
- Nagoya University School of Health Sciences, Nagoya University Hospital
| | - Takao Nishizawa
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Yuki Hara
- Department of Pathophysiology Laboratory Sciences
| | - Mari Sugiura
- Department of Pathophysiology Laboratory Sciences
| | - Shigeo Iino
- Department of Clinical Laboratory, Nagoya University Hospital
| | - Kohzo Nagata
- Nagoya University School of Health Sciences, Nagoya University Hospital
| | - Yasuo Koike
- Nagoya University School of Health Sciences, Nagoya University Hospital
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
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9
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Shiota T. 3D echocardiography: The present and the future. J Cardiol 2008; 52:169-85. [DOI: 10.1016/j.jjcc.2008.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Accepted: 09/04/2008] [Indexed: 12/14/2022]
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Abstract
The introduction of three-dimensional (3D) imaging and its evolution from slow and labor-intense off-line reconstruction to real-time volumetric imaging is one of the most significant developments in ultrasound imaging of the heart of the past decade. This imaging modality currently provides valuable clinical information that empowers echocardiography with new levels of confidence in diagnosing heart disease. One major advantage of seeing the additional dimension is the improvement in the accuracy of the evaluation of cardiac chamber volumes by eliminating geometric modeling and the errors caused by foreshortened views. Another benefit of 3D imaging is the realistic views of cardiac valves capable of demonstrating numerous pathologies in a unique, noninvasive manner. This article reviews the major technological developments in 3D echocardiography and some of the recent literature that has provided the scientific basis for its clinical use.
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11
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Mor-Avi V, Lang RM. Three-Dimensional Echocardiographic Evaluation of the Heart Chambers: Size, Function, and Mass. Cardiol Clin 2007; 25:241-51. [PMID: 17765103 DOI: 10.1016/j.ccl.2007.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The major advantage of three-dimensional (3D) ultrasound imaging of the heart is the improvement in the accuracy of the echocardiographic evaluation of cardiac chamber volumes, which is achieved by eliminating the need for geometric modeling and the errors caused by foreshortened 2D views. In this article, we review the literature that has provided the scientific basis for the clinical use of 3D ultrasound imaging of the heart in the assessment of cardiac chamber size, function, and mass, and discuss its potential future applications.
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Affiliation(s)
- Victor Mor-Avi
- Section of Cardiology, Department of Medicine, University of Chicago, MC5084, 5841 S. Maryland Avenue, Chicago, IL 60637, USA.
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12
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Lang RM, Mor-Avi V, Sugeng L, Nieman PS, Sahn DJ. Three-Dimensional Echocardiography. J Am Coll Cardiol 2006; 48:2053-69. [PMID: 17112995 DOI: 10.1016/j.jacc.2006.07.047] [Citation(s) in RCA: 177] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2006] [Revised: 07/06/2006] [Accepted: 07/10/2006] [Indexed: 10/24/2022]
Abstract
Over the past 3 decades, echocardiography has become a major diagnostic tool in the arsenal of clinical cardiology for real-time imaging of cardiac dynamics. More and more, cardiologists' decisions are based on images created from ultrasound wave reflections. From the time ultrasound imaging technology provided the first insight into the human heart, our diagnostic capabilities have increased exponentially as a result of our growing knowledge and developing technology. One of the most significant developments of the last decades was the introduction of 3-dimensional (3D) imaging and its evolution from slow and labor-intense off-line reconstruction to real-time volumetric imaging. While continuing its meteoric rise instigated by constant technological refinements and continuing increase in computing power, this tool is guaranteed to be integrated in routine clinical practice. The major proven advantage of this technique is the improvement in the accuracy of the echocardiographic evaluation of cardiac chamber volumes, which is achieved by eliminating the need for geometric modeling and the errors caused by foreshortened views. Another benefit of 3D imaging is the realistic and unique comprehensive views of cardiac valves and congenital abnormalities. In addition, 3D imaging is extremely useful in the intraoperative and postoperative settings because it allows immediate feedback on the effectiveness of surgical interventions. In this article, we review the published reports that have provided the scientific basis for the clinical use of 3D ultrasound imaging of the heart and discuss its potential future applications.
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Affiliation(s)
- Roberto M Lang
- Cardiac Imaging Center, Department of Medicine, University of Chicago, Chicago, Illinois 60637, USA.
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13
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Jung HO, Sheehan FH, Bolson EL, Waiss MP, Otto CM. Evaluation of Midwall Systolic Function in Left Ventricular Hypertrophy: A Comparison of 3-Dimensional Versus 2-Dimensional Echocardiographic Indices. J Am Soc Echocardiogr 2006; 19:802-10. [PMID: 16762760 DOI: 10.1016/j.echo.2006.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2005] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study investigated the sensitivity of 3-dimensional (3D) midwall ejection fraction (EF) (3DEF(mw)) to the presence of left ventricular (LV) hypertrophy (LVH) in comparison with conventional echocardiographic indices for systolic function. BACKGROUND EF and fractional shortening (FS) do not reflect the prognosis of patients with LVH. Midwall mechanics better represent the true function in LVH. However, midwall FS (FS(mw)) interrogates a limited region of LV. We developed a method for determining 3DEF(mw). METHODS This study compared 3DEF(mw) with 2-dimensional (endocardial EF [EF(endo)], endocardial FS, FS(mw), and systolic tissue velocity) and 3D (3D EF(endo) and mitral annular motion [MAM]) echocardiographic indices in 28 patients with essential hypertension and LV mass index by M-mode greater than 125 g/m(2) versus 21 healthy individuals. RESULTS Systolic function assessed by EF(endo), endocardial FS, 3D EF(endo), and systolic tissue velocity did not differ between the two groups, but MAM (11.6 vs 14.0 mm), FS(mw) (14.7 vs 18.2%), and 3DEF(mw) (36.6 vs 44.1%) were significantly decreased in LVH compared with normal. Only 3 parameters correlated significantly with both the M-mode and 3D measurements of LV mass index: FS(mw) (r = -0.74 [M-mode]; r = -0.48 [3D]), 3DEF(mw) (r = -0.63 [M-mode]; r = -0.68 [3D]), and MAM (r = -0.43 [M-mode]; r = -0.36 [3D]). Midwall indices FS(mw) (F = 40.4) and 3DEF(mw) (F = 26.5) better discriminated LVH and normal groups than MAM or endocardial indices. CONCLUSIONS The 3DEF(mw) method discriminates the systolic function of LVH and normal groups, and correlates with the degree of hypertrophy. By avoiding the limitations of FS(mw) or MAM, 3DEF(mw) provides a more comprehensive metric of systolic function in patients with LVH.
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Affiliation(s)
- Hae Ok Jung
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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Thaman R, Gimeno JR, Murphy RT, Kubo T, Sachdev B, Mogensen J, Elliott PM, McKenna WJ. Prevalence and clinical significance of systolic impairment in hypertrophic cardiomyopathy. Heart 2005; 91:920-5. [PMID: 15958362 PMCID: PMC1768999 DOI: 10.1136/hrt.2003.031161] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To determine the frequency of systolic impairment (SI) and its impact on the natural history of hypertrophic cardiomyopathy (HCM). METHODS 1080 patients (mean (SD) age 43 (15) years, 660 men) with HCM were evaluated. Initial assessment included history, examination, 48 hour Holter monitoring, cardiopulmonary exercise testing, and echocardiography; SI was defined as a fractional shortening (FS) < or = 25%. Survival data were collected at clinic visits or by direct communication with patients and their general practitioners. The results of serial echocardiography in 462 patients with normal FS at presentation are also reported. RESULTS 26 (2.4%) patients (49 (14) years, 18 men) had SI at the initial visit. During follow up (58 (49) months), nine (34.6%) died or underwent cardiac transplantation compared with 108 (10.2%) patients with normal FS (p = 0.01). Five year survival from death (any cause) or transplantation was 90.1% (95% confidence interval (CI) 87.8 to 92.4) in patients with normal systolic function versus 52.4% (95% CI 25.2 to 79.6, p < 0.0001) in patients with SI. In patients who underwent serial echocardiography, 22 (4.8%, aged 41 (15) years) developed SI over 66 (40) months; the annual incidence of SI was 0.87% (95% CI 0.54 to 1.31). On initial evaluation patients who developed SI had a higher frequency of syncope (67 (15.2%) v 10 (45.5%) of those who did not develop SI, p = 0.001), non-sustained ventricular tachycardia (91 (20.6%) v 11 (50%), p = 0.002), and an abnormal blood pressure response on exercise (131 (29.7%) v 15 (68.2%), p = 0.001). Patients with SI had greater wall thinning (p = 0.001), left ventricular cavity enlargement (p < 0.0005), and deterioration in New York Heart Association functional class (p = 0.001) during follow up. Thirteen (59.1%) patients who progressed to SI died or underwent transplantation compared with 38 (8.6%) patients who maintained normal systolic function. CONCLUSIONS SI is an infrequent complication of HCM but, when present, is associated with a poor prognosis.
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Affiliation(s)
- R Thaman
- The Heart Hospital, University College London, London, UK
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15
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Wang CL, Tanabe K, Kawai J, Tani T, Kuo CT, Morioka S. Evaluation of Regional Left Ventricular Function by Three-dimensional Echocardiography. J Echocardiogr 2005. [DOI: 10.2303/jecho.3.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Frielingsdorf J, Franke A, Hess OM, Flachskampf FA. Are there sex differences in regional systolic function and wall stress in hypertrophic obstructive cardiomyopathy? A three-dimensional echocardiography study. J Am Soc Echocardiogr 2004; 17:638-43. [PMID: 15163935 DOI: 10.1016/j.echo.2004.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Sex-related differences in left ventricular (LV) systolic function have been previously reported in patients with aortic stenosis and hypertensive heart disease. The goal of this study was to determine systolic function of the LV in male and female patients with hypertrophic obstructive cardiomyopathy and to relate it to wall thickness and wall stress, respectively. BACKGROUND Wall thickening, a parameter of regional systolic function, is determined by wall thickness and wall stress. A comprehensive analysis of regional LV function was performed from multiplane transesophageal echocardiography with 3-dimensional reconstruction of the LV. METHODS In 21 patients (11 men and 10 women) 4 parallel (2 basal and 2 apical) equidistant short-axis cross sections from base to apex were obtained from the reconstructed LV. In each short axis, 24 wall-thickness measurements were carried out in 15-degree intervals at end-diastole (ED) and end-systole. Thus, a total of 192 measurements were obtained in each patient. Wall thickening, a parameter of regional systolic function, was calculated as the difference of ED and end-systolic wall thickness, and fractional thickening as thickening divided by ED thickness. RESULTS Fractional thickening and wall stress were inversely related to ED wall thickness in both men and women. Women showed better LV systolic function when compared with men (P <.001). However, when corrected for wall stress, which was lower in women, there was no sex difference in systolic function. CONCLUSIONS There are regional differences in LV systolic function in men and women that depend on regional wall thickness and wall stress.
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18
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Tam JW, Shaikh N, Sutherland E. Echocardiographic assessment of patients with hypertrophic and restrictive cardiomyopathy: imaging and echocardiography. Curr Opin Cardiol 2002; 17:470-7. [PMID: 12357122 DOI: 10.1097/00001573-200209000-00005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Echocardiography has evolved to be an important tool in the assessment of patients with hypertrophic and restrictive cardiomyopathy. In this article, the authors review the use of echocardiography in diagnosis, differentiation from disease mimics, assessment of prognosis, and the assistance of specific therapies. A pathophysiologic understanding of restrictive cardiomyopathy and constrictive pericarditis will be reviewed along with echocardiographic and Doppler features that help to distinguish these two entities.
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Affiliation(s)
- James W Tam
- Section of Cardiology, Department of Medicine, University of Manitoba Health Sciences Center, Winnipeg, Manitoba, Canada.
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Mondelli JA, Di Luzio S, Nagaraj A, Kane BJ, Smulevitz B, Nagaraj AV, Greene R, McPherson DD, Rigolin VH. The validation of volumetric real-time 3-dimensional echocardiography for the determination of left ventricular function. J Am Soc Echocardiogr 2001; 14:994-1000. [PMID: 11593204 DOI: 10.1067/mje.2001.115770] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The objective of this study was to validate a real-time 3-dimensional echocardiography (3DE) technique for the determination of left ventricular (LV) volume and ejection fraction (EF). In 10 mongrel dogs, an electromagnetic flow (EMF) probe was placed on the aorta, and the thorax was closed. Transthoracic imaging was performed during multiple hemodynamic conditions (n = 58) with simultaneous measurement of stroke volume (SV) with the use of EMF. From the volumetric data set, LV volumes were manually traced off-line by 2 independent observers with an apical rotation method (6 planes) and a conventional method (biplane) in a subset of conditions. This tracing technique was also evaluated in 18 human subjects in whom the calculated EF values were compared with values derived by multigated radionuclide angiography (MUGA). Excellent correlation and close limits of agreement were noted between SV measured by 3DE and EMF (r = 0.93) in dogs. In comparison with EMF-derived SV, 3DE provided better correlation than the biplane method (r = 0.93 versus r = 0.61). Interobserver and intraobserver variabilities were comparable (r = 0.94 and r = 0.94, respectively). In a comparison of MUGA-derived EF values and those obtained by 3DE in human subjects, 3DE provided better correlation than the biplane method (r = 0.94 versus r = 0.85). Real-time 3DE accurately measures left ventricular volumes transthoracically over a wide range of hemodynamic conditions in dogs and accurately determines EF in humans.
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Affiliation(s)
- J A Mondelli
- Feinberg Cardiovascular Research Institute, Northwestern University Medical School, Chicago, Ill, USA
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20
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Frielingsdorf J, Franke A, Kühl HP, Hess OM, Flachskampf FA. Evaluation of septal hypertrophy and systolic function in diseases that cause left ventricular hypertrophy: a 3-dimensional echocardiography study. J Am Soc Echocardiogr 2001; 14:370-7. [PMID: 11337682 DOI: 10.1067/mje.2001.112674] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The goals of this study were to determine regional systolic function of the septum and to relate it to regional wall thickness and wall stress. BACKGROUND Wall thickening, a parameter of systolic function, is determined by wall thickness and wall stress. In patients with hypertrophic obstructive cardiomyopathy (HOCM), hypertrophic nonobstructive cardiomyopathy (HNCM), and hypertensive heart disease (HHD), regional systolic function of normal and hypertrophic septal regions has been incompletely characterized by 2-dimensional echocardiography. Thus, multiplane transesophageal echocardiography with 3-dimensional reconstruction of the septum was used. METHODS AND RESULTS In 49 patients (15 controls, 11 with HOCM, 8 with HNCM, and 15 with HHD) 4 parallel (2 basal and 2 apical) equidistant short-axis cross sections from base to apex were obtained from the reconstructed septum. In each short-axis cross section, 6 wall-thickness measurements were made in 15 degrees intervals at end diastole and end systole, for a total of 48 measurements in each patient. Fractional thickening was calculated as wall thickening divided by end-diastolic wall thickness. Wall thickness of the basal cross sections was significantly thicker (P < .001) in HOCM and HNCM than in HHD. However, circumferential wall thickness was more evenly distributed in HNCM and HHD when compared with HOCM. In the basal cross sections, fractional thickening was similarly reduced in all hearts, though basal wall stress was significantly different in all groups (P < .001). In the apical cross sections, wall thickness was similar in all diseased hearts, but fractional thickening was better (P < .001) and wall stress lower (P < .001) in HNCM than in HOCM and HHD. CONCLUSIONS In septal regions without or with only mild hypertrophy, regional systolic function is preserved and appears to be determined by hemodynamic factors such as wall stress. However, in regions with moderate to severe hypertrophy, systolic function is markedly and uniformly impaired in all groups, which seems not to be caused by differences in wall thickness and wall stress but by the degree of the myocardial disease process.
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Affiliation(s)
- J Frielingsdorf
- Medical Clinic I, Rheinisch-Westfälische Technische Hochschule, Aachen, Germany
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21
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Kühl HP, Bücker A, Franke A, Maul S, Nolte-Ernsting C, Reineke T, Hoffmann R, Günther RW, Hanrath P. Transesophageal 3-dimensional echocardiography: in vivo determination of left ventricular mass in comparison with magnetic resonance imaging. J Am Soc Echocardiogr 2000. [PMID: 10708469 DOI: 10.1067/mje.2000.104474] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The objective of this study was to assess the accuracy and reproducibility of transesophageal 3-dimensional echocardiography (3DE) in comparison with magnetic resonance imaging (MRI) for the in vivo calculation of left ventricular mass (LVM). In addition, mass values obtained by M-mode echocardiography were compared with those calculated by MRI. Three-dimensional reconstruction of the left ventricle was performed from a transesophageal and transgastric transducer position with a multiplane transducer in 20 patients. Left ventricular mass was calculated from both transducer positions by using slices of various thicknesses, ranging from 5 to 20 mm. Reproducibility was determined by 5 repeated measurements of mass in each of 5 randomly selected left ventricles. M-mode echocardiography was performed according to the method described by Devereux. For MRI, multiple short-axis views with 10-mm slice thickness were acquired in inspiration hold. Correlation was high for mass determined by 3DE and MRI (for 10-mm slice thickness: r = 0.99; y = 0.99 x - 0.7 g; standard error of estimate = 8.5 g; P <.001). There was no statistical bias, and the limits of agreement ranged from +/-16.4 g to +/-27.2 g, depending on the slice thickness. Variability was lowest for a slice thickness of 10 mm (SD +/- 8.2 g). The reproducibility of mass determination was excellent (mean width of the 95% CI 12.8 g). Left ventricular mass values calculated from the transgastric and transesophageal transducer position were not different from each other (mean bias 0.6 +/- 9.1 g; P = ns). M-mode-based LVM calculations showed systematic overestimation and large measurement variability (bias 23.7 g; 95% CI +/- 92.8 g). Compared with MRI, transesophageal 3DE is an accurate and reproducible method for the determination of LVM and clearly superior to M-mode echocardiography.
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Affiliation(s)
- H P Kühl
- Medical Clinic I, Department of Radiology, University Hospital, Aachen, Germany.
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22
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Lim DS, Oberst L, McCluggage M, Youker K, Lacy J, DeMayo F, Entman ML, Roberts R, Michael LH, Marian AJ. Decreased left ventricular ejection fraction in transgenic mice expressing mutant cardiac troponin T-Q(92), responsible for human hypertrophic cardiomyopathy. J Mol Cell Cardiol 2000; 32:365-74. [PMID: 10731436 DOI: 10.1006/jmcc.1999.1081] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The causality of mutant sarcomeric proteins in hypertrophic cardiomyopathy (HCM) is well established. The current emphasis is to elucidate the pathogenesis of HCM in transgenic animal models. We determined the left ventricular ejection fraction (LVEF) in transgenic mice expressing mutant cardiac troponin T (cTnT)-Q(92), known to cause HCM in humans. Transgenes were constructed by placing wild-type (R(92)) or mutant (Q(92)) full-length human cTnT cDNAs 3' into a 5.5-kb murine [alpha -myosin heavy chain (MyHC)] promoter injected into fertilized zygotes. Three wild-type and six mutant lines were produced. Transgene mRNA and proteins, detected using transgene-specific probes were expressed at high levels in all wild-type and three mutant lines. The total cTnT mRNA pool was increased by up to five-fold in transgenic mice, but the total cTnT protein remained unchanged. The mean values of LVEF, determined by(178)Ta radionuclide angiography, were 57.8+/-6% (n=4) in non-transgenic littermate (NLM), 53.3+/-10 (n=6) in wild-type and 39. 4+/-6 (n=5) in mutant transgenic mice (P=0.009). The heart/body weight ratios and the number of cells stained with terminal deoxynucleotidyl transferase (TdT)-mediated nick end-labeling were similar among the groups. Three mutant mice had myocyte disarray and excess interstitial collagen and two had normal myocardial structure despite having reduced LVEF. Thus, in vivo expression of the mutant cTnT-Q(92)protein, responsible for human HCM, impaired global cardiac systolic function in transgenic mice, which also occurred in the absence of myocyte disarray and increased interstitial collagen.
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Affiliation(s)
- D S Lim
- Section of Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
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