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Lin Y, Zhang L, Hu X, Gao L, Ji M, He Q, Xie M, Li Y. Clinical Usefulness of Speckle-Tracking Echocardiography in Patients with Heart Failure with Preserved Ejection Fraction. Diagnostics (Basel) 2023; 13:2923. [PMID: 37761290 PMCID: PMC10529773 DOI: 10.3390/diagnostics13182923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/20/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is defined as HF with left ventricular ejection fraction (LVEF) not less than 50%. HFpEF accounts for more than 50% of all HF patients, and its prevalence is increasing year to year with the aging population, with its prognosis worsening. The clinical assessment of cardiac function and prognosis in patients with HFpEF remains challenging due to the normal range of LVEF and the nonspecific symptoms and signs. In recent years, new echocardiographic techniques have been continuously developed, particularly speckle-tracking echocardiography (STE), which provides a sensitive and accurate method for the comprehensive assessment of cardiac function and prognosis in patients with HFpEF. Therefore, this article reviewed the clinical utility of STE in patients with HFpEF.
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Affiliation(s)
- Yixia Lin
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Y.L.); (L.Z.); (X.H.); (L.G.); (M.J.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Li Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Y.L.); (L.Z.); (X.H.); (L.G.); (M.J.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Xiaoqing Hu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Y.L.); (L.Z.); (X.H.); (L.G.); (M.J.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Lang Gao
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Y.L.); (L.Z.); (X.H.); (L.G.); (M.J.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Mengmeng Ji
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Y.L.); (L.Z.); (X.H.); (L.G.); (M.J.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Qing He
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Y.L.); (L.Z.); (X.H.); (L.G.); (M.J.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Y.L.); (L.Z.); (X.H.); (L.G.); (M.J.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yuman Li
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Y.L.); (L.Z.); (X.H.); (L.G.); (M.J.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
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Venous dysfunction in obstructive hypertrophic cardiomyopathies: Results from the “HCM-Vein” pilot study. IJC HEART & VASCULATURE 2023; 45:101198. [PMID: 36993942 PMCID: PMC10040706 DOI: 10.1016/j.ijcha.2023.101198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/08/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023]
Abstract
Background Hypertrophic cardiomyopathies (HCM) can be complicated by left ventricular outflow-tract obstruction (LVOTO) responsible for disabling exercise symptoms, a phenomenon influenced by hemodynamic factors including venous return. Methods We aimed to evaluate venous dysfunction in obstructive HCM patients compared to healthy controls, and to investigate the relationship between venous dysfunction parameters and LVOTO in HCM. This is a clinical, monocentric, prospective, pilot study, in a tertiary care center. We investigated venous function using venous air plethysmography, and endothelial function. Results Among the 30 symptomatic obstructive HCM patients, 30% (n = 9) presented abnormal venous residual volume fraction (RVFv) which translates in elevated ambulatory venous pressure vs. 0% in the 10 healthy controls (p < 0.05). Comparing obstructive HCM patients with abnormal RVFv (n = 9) to other obstructive HCM patients with normal RVFv (n = 21), there were no significant differences in terms of age, sex (67% male), and classical echocardiographic parameters both at rest and during exercise, except for left ventricular end-diastolic volume index which was significantly lower in the group with abnormal RVFv compared to the other HCM patients (40.1 ± 9.0 ml/m2vs. 50.2 ± 10.6 ml/m2, p = 0.01). Fifty six percent of obstructive HCM patients with abnormal RVFv had an absolute increase in Willebrand factor (vs. 26% of other obstructive HCM patients, p < 0.05). Conclusions In this pilot monocentric study, venous insufficiency was observed in about 30% of symptomatic obstructive HCM patients. Patients with venous insufficiency had more frequently a smaller LV cavity volume. Due to the small sample size, this study is only hypothesis-generating, and further investigations are needed.
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She J, Zhao S, Chen Y, Zeng M, Jin H. Detecting Regional Fibrosis in Hypertrophic Cardiomyopathy: The Utility of Myocardial Strain Based on Cardiac Magnetic Resonance. Acad Radiol 2023; 30:230-238. [PMID: 35469720 DOI: 10.1016/j.acra.2022.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 01/11/2023]
Abstract
RATIONALE AND OBJECTIVES The value of myocardial strain for reflecting fibrosis in patients with hypertrophic cardiomyopathy (HCM) on cardiac magnetic resonance (CMR) has not been definite. We aim to explore whether there are underlying non-contrast parameters to evaluate myocardial fibrosis and screen which may be the best. MATERIALS AND METHODS We retrospectively included 127 HCM patients (89 men; average age 46.6 ± 15.6 years) and 30 healthy controls (20 men; average age 52.0 ± 13.2 years) who have undergone late gadolinium enhancement (LGE) CMR. Next, 127 HCM patients were divided randomly into two sets including training cohort and validation cohort. Strain and imaging parameters were measured and analyzed statistically. RESULTS Based on univariate and multivariate analysis, segmental circumferential strain (SCS) (p < 0.001) and maximal wall thickness (MWT) (p < 0.001) may differentiate myocardial segments with or without LGE as significant biomarkers for both sets. The area under the curve (AUC) was 0.803 (95% CI 0.785-0.820) for SCS and 0.777 (95% CI 0.759-0.795) for MWT to identify myocardial fibrosis. When combining SCS >-13.9% and MWT >16.4mm, the specificity of the model (AUC = 0.779; 95% CI 0.760-0.796) achieved the highest 93.9%, with a sensitivity of 61.8%. CONCLUSION Strain analysis in HCM holds promise for myocardial fibrosis detection and SCS is the best strain parameter based on CMR. Nevertheless, the model of combining SCS and MWT could achieve the highest specificity for fibrotic diagnosis.
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Affiliation(s)
- Jiaqi She
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China; Department of Medical Imaging, Shanghai Medical school, Fudan University, Shanghai, China
| | - Shihai Zhao
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China; Department of Medical Imaging, Shanghai Medical school, Fudan University, Shanghai, China
| | - Yinyin Chen
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China; Department of Medical Imaging, Shanghai Medical school, Fudan University, Shanghai, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China; Department of Medical Imaging, Shanghai Medical school, Fudan University, Shanghai, China
| | - Hang Jin
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China; Department of Medical Imaging, Shanghai Medical school, Fudan University, Shanghai, China.
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Hwang JW, Lee SC, Kim D, Kim J, Kim EK, Chang SA, Park SJ, Kim SM, Choe YH, Park SW. Role of cardiovascular magnetic resonance imaging and cardiopulmonary exercise test in predicting composite clinical outcomes in patients with hypertrophic cardiomyopathy. PLoS One 2023; 18:e0285887. [PMID: 37192184 DOI: 10.1371/journal.pone.0285887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/04/2023] [Indexed: 05/18/2023] Open
Abstract
We aimed to evaluate the additive value of cardiovascular magnetic resonance imaging (CMR) and cardiopulmonary exercise test (CPET) to predict clinical outcomes in patients with HCM. We enrolled 373 patients with HCM and normal left ventricular systolic function who underwent CPET and CMR. The primary outcome was a clinical composite of all-cause death, cardiac transplantation, stroke, heart failure requiring hospitalization and defibrillator implantation. During a follow-up of 70.70 ± 30.74 months, there were 84 composite clinical events. Peak oxygen consumption during CPET was significantly lower (18.51±13.25 vs. 24.59±13.28 mL/kg/min, p < 0.001) and abnormal hemodynamic response to exercise was more frequently detected (41.7 vs. 20.8%, p<0.001) in the group with composite clinical events. The extent of late gadolinium enhancement was larger in the event group (15.39±10.53 vs. 11.97±9.53%LV, p<0.001). Selective parameters were added stepwise to conventional clinical parameters; the final model, where CPET and CMR parameters were added, was verified to have the highest increment value for clinical outcome prediction (p<0.001). This study demonstrated that CPET and CMR findings may be important clinical tools for risk stratification in HCM. Exercise capacity was an independent predictor of composite outcomes in patients with HCM, with incremental value as a risk factor when added to the alleged parameters. These findings could help physicians monitor and manage patients with HCM in the real clinical field.
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Affiliation(s)
- Ji-Won Hwang
- Division of Cardiology, Department of Medicine, Ilsan Paik Hospital, Inje University School of Medicine, Goyang, Korea
| | - Sang-Chol Lee
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Darae Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jihoon Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Kyoung Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung-A Chang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung-Ji Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Mok Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeon Hyeon Choe
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Woo Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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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: 0] [Impact Index Per Article: 0] [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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Gao L, Lin Y, Ji M, Wu W, Li H, Qian M, Zhang L, Xie M, Li Y. Clinical Utility of Three-Dimensional Speckle-Tracking Echocardiography in Heart Failure. J Clin Med 2022; 11:6307. [DOI: 10.3390/jcm11216307] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
Heart failure (HF) is an extremely major health problem with gradually increasing incidence in developed and developing countries. HF may lead to cardiac remodeling; thus, advanced imaging techniques are required to comprehensively evaluate cardiac mechanics. Recently, three-dimensional speckle-tracking echocardiography (3D-STE) has been developed as a novel imaging technology that is based on the three-dimensional speckle-tracking on the full volume three-dimensional datasets. Three-dimensional speckle-tracking echocardiography allows a more accurate evaluation of global and regional myocardial performance, assessment of cardiac mechanics, detection of subclinical cardiac dysfunction, and prediction of adverse clinical events in a variety of cardiovascular diseases. Therefore, this review summarizes the clinical usefulness of 3D-STE in patients with HF.
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Molecular Approaches and Echocardiographic Deformation Imaging in Detecting Myocardial Fibrosis. Int J Mol Sci 2022; 23:ijms231810944. [PMID: 36142856 PMCID: PMC9501415 DOI: 10.3390/ijms231810944] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/11/2022] [Accepted: 09/16/2022] [Indexed: 12/25/2022] Open
Abstract
The pathological remodeling of myocardial tissue is the main cause of heart diseases. Several processes are involved in the onset of heart failure, and the comprehension of the mechanisms underlying the pathological phenotype deserves special attention to find novel procedures to identify the site of injury and develop novel strategies, as well as molecular druggable pathways, to counteract the high degree of morbidity associated with it. Myocardial fibrosis (MF) is recognized as a critical trigger for disruption of heart functionality due to the excessive accumulation of extracellular matrix proteins, in response to an injury. Its diagnosis remains focalized on invasive techniques, such as endomyocardial biopsy (EMB), or may be noninvasively detected by cardiac magnetic resonance imaging (CMRI). The detection of MF by non-canonical markers remains a challenge in clinical practice. During the last two decades, two-dimensional (2D) speckle tracking echocardiography (STE) has emerged as a new non-invasive imaging modality, able to detect myocardial tissue abnormalities without specifying the causes of the underlying histopathological changes. In this review, we highlighted the clinical utility of 2D-STE deformation imaging for tissue characterization, and its main technical limitations and criticisms. Moreover, we focalized on the importance of coupling 2D-STE examination with the molecular approaches in the clinical decision-making processes, in particular when the 2D-STE does not reflect myocardial dysfunction directly. We also attempted to examine the roles of epigenetic markers of MF and hypothesized microRNA-based mechanisms aiming to understand how they match with the clinical utility of echocardiographic deformation imaging for tissue characterization and MF assessment.
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Klettas D, Georgiopoulos G, Rizvi Q, Oikonomou D, Magkas N, Bhuva AN, Manisty C, Captur G, Aimo A, Nihoyannopoulos P. Echocardiographic and Cardiac Magnetic Resonance Imaging-Derived Strains in Relation to Late Gadolinium Enhancement in Hypertrophic Cardiomyopathy. Am J Cardiol 2022; 171:132-139. [PMID: 35305784 DOI: 10.1016/j.amjcard.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/28/2022] [Accepted: 02/01/2022] [Indexed: 11/01/2022]
Abstract
We compared speckle tracking echocardiography (STE) and feature tracking cardiovascular magnetic resonance (FT-CMR) in patients with hypertrophic cardiomyopathy (HC) with a varying extent of fibrosis as defined by late gadolinium enhancement to look at the level of agreement between methods and their ability to relate those to myocardial fibrosis. At 2 reference centers, 79 patients with HC and 16 volunteers (the control group) underwent STE and CMR with late gadolinium enhancement and FT-CMR. Patients were classified into 3 categories: no detectable, limited, and extensive fibrosis. Global longitudinal strain (GLS) and global radial strain (GRS) were derived using FT-CMR and STE. STE-derived GRS was decreased in all HC categories compared with the control group (p <0.001), whereas FT-CMR GRS was reduced only in patients with HC with fibrosis (p <0.05). Reduced STE-derived GLS was associated with extensive fibrosis (p <0.05) and a value less than -15.2% identified those with extensive fibrosis (sensitivity 79%, specificity 92%, area under the curve 0.863, 95% confidence interval [CI] 0.76 to 0.97, p <0.001). Inter-modality agreement was moderate for STE versus CMR-GLS (overall population intra-class correlation coefficient = 0.615, 95% CI 0.42 to 0.75, p <0.001; patients with HC 0.63, 0.42 to 0.76, p <0.001) and GRS (overall population intra-class correlation coefficient = 0.601, 95% CI 0.397 to 0.735, p <0.001). A low level of agreement for GRS was seen between methods in patients with HC. In conclusion, strain indexes measured using echocardiography and CMR are reduced in patients with HC compared with the control group and correlate well with the burden of myocardial fibrosis. Reduced STE-GLS can identify patients with extensive fibrosis, but whether there is an added value for risk stratification for sudden cardiac death remains to be determined.
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Affiliation(s)
- Dimitrios Klettas
- Imperial College London, National Heart and Lung Institute, Hammersmith Hospital, London, United Kingdom; First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Greece
| | - Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom
| | - Qaima Rizvi
- Imperial College London, National Heart and Lung Institute, Hammersmith Hospital, London, United Kingdom
| | | | - Nikolaos Magkas
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Greece
| | - Anish N Bhuva
- Department of Cardiovascular Imaging, Barts Heart Center, London, United Kingdom; University College London Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Charlotte Manisty
- Department of Cardiovascular Imaging, Barts Heart Center, London, United Kingdom; University College London Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Gabriella Captur
- Royal Free London, National Health Service Foundation Trust, London, United Kingdom; University College London Medical Research Council Unit for Lifelong Health and Aging, University College London, London, United Kingdom; University College London Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Alberto Aimo
- Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy; Cardiology Department, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Petros Nihoyannopoulos
- Imperial College London, National Heart and Lung Institute, Hammersmith Hospital, London, United Kingdom; First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Greece.
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Rodrigues T, Raposo SC, Brito D, Lopes LR. Prognostic relevance of exercise testing in hypertrophic cardiomyopathy. A systematic review. Int J Cardiol 2021; 339:83-92. [PMID: 34214502 PMCID: PMC8425182 DOI: 10.1016/j.ijcard.2021.06.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/21/2021] [Accepted: 06/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiopulmonary exercise test (CPET) is indicated as part of the assessment in hypertrophic cardiomyopathy (HCM) patients and stress echocardiography is often used to assess symptoms. However, the role of exercise testing for prognostic stratification in HCM is still not established. AIMS To systematically review the evidence on the role of exercise testing for prognostic stratification in hypertrophic cardiomyopathy. METHODS A systematic review was conducted for eligible publications, between 2010 and 2020, that included evaluation of outcomes and prognosis. In these studies, patients underwent exercise echocardiography and/or cardiopulmonary exercise testing, performed according to predefined protocols. Diverse parameters were assessed in order to determine which were relevant for the prognosis. Analyzed outcomes included death from any cause, sudden cardiac death (SCD) and equivalents, cardiovascular death, heart failure requiring hospitalization or progression to New York Heart Association classes III or IV, cardiac transplantation, non-sustained ventricular tachycardia, stroke, myocardial infarction and invasive septal reduction therapy. RESULTS Eighteen publications were included, corresponding to a total of 7525 patients. The mean follow-up period varied between 1 and 8 years. The main findings of these studies revealed that the major predictors of outcomes were abnormal heart rate recovery, abnormal blood pressure response exercise induced wall motion abnormalities, lower peak VO2, higher VE/VCO2, and pulmonary hypertension/exercise-induced pulmonary hypertension. CONCLUSION Although most studies concluded that exercise test results are useful to determine prognosis in HCM, further investigation is needed regarding whether it adds independent value to the current risk stratification strategies.
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Affiliation(s)
- Tiago Rodrigues
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal; CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Sofia Cavaco Raposo
- Unidade de Saúde Familiar Reynaldo dos Santos, Agrupamento de Centros de Saúde Estuário do Tejo, Administração Regional de Saúde Lisboa e Vale do Tejo, Portugal; Lisbon School of Medicine, Universidade de Lisboa, Lisboa, Portugal
| | - Dulce Brito
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal; CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Luis R Lopes
- CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal; Barts Heart Centre, St. Bartholomew's Hospital, London, UK; Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, UK.
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10
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Bayonas-Ruiz A, Muñoz-Franco FM, Ferrer V, Pérez-Caballero C, Sabater-Molina M, Tomé-Esteban MT, Bonacasa B. Cardiopulmonary Exercise Test in Patients with Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10112312. [PMID: 34070695 PMCID: PMC8198116 DOI: 10.3390/jcm10112312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 05/16/2021] [Accepted: 05/23/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patients with chronic diseases frequently adapt their lifestyles to their functional limitations. Functional capacity in Hypertrophic Cardiomyopathy (HCM) can be assessed by stress testing. We aim to review and analyze the available data from the literature on the value of Cardiopulmonary Exercise Test (CPET) in HCM. Objective measurements from CPET are used for evaluation of patient response to traditional and new developing therapeutic measurements. METHODS A systematic review of the literature was conducted in PubMed, Web of Science and Cochrane in Mar-20. The original search yielded 2628 results. One hundred and two full texts were read after the first screening, of which, 69 were included for qualitative synthesis. Relevant variables to be included in the review were set and 17 were selected, including comorbidities, body mass index (BMI), cardiac-related symptoms, echocardiographic variables, medications and outcomes. RESULTS Study sample consisted of 69 research articles, including 11,672 patients (48 ± 14 years old, 65.9%/34.1% men/women). Treadmill was the most common instrument employed (n = 37 studies), followed by upright cycle-ergometer (n = 16 studies). Mean maximal oxygen consumption (VO2max) was 22.3 ± 3.8 mL·kg-1·min-1. The highest average values were observed in supine and upright cycle-ergometer (25.3 ± 6.5 and 24.8 ± 9.1 mL·kg-1·min-1; respectively). Oxygen consumption in the anaerobic threshold (ATVO2) was reported in 18 publications. Left ventricular outflow tract gradient (LVOT) > 30 mmHg was present at baseline in 31.4% of cases. It increased to 49% during exercise. Proportion of abnormal blood pressure response (ABPRE) was higher in severe (>20 mm) vs. mild hypertrophy groups (17.9% vs. 13.6%, p < 0.001). Mean VO2max was not significantly different between severe vs. milder hypertrophy, or for obstructive vs. non-obstructive groups. Occurrence of arrhythmias during functional assessment was higher among younger adults (5.42% vs. 1.69% in older adults, p < 0.001). Twenty-three publications (9145 patients) evaluated the prognostic value of exercise capacity. There were 8.5% total deaths, 6.7% cardiovascular deaths, 3.0% sudden cardiac deaths (SCD), 1.2% heart failure death, 0.6% resuscitated cardiac arrests, 1.1% transplants, 2.6% implantable cardioverter defibrillator (ICD) therapies and 1.2 strokes (mean follow-up: 3.81 ± 2.77 years). VO2max, ATVO2, METs, % of age-gender predicted VO2max, % of age-gender predicted METs, ABPRE and ventricular arrhythmias were significantly associated with major outcomes individually. Mean VO2max was reduced in patients who reached the combined cardiovascular death outcome compared to those who survived (-6.20 mL·kg-1·min-1; CI 95%: -7.95, -4.46; p < 0.01). CONCLUSIONS CPET is a valuable tool and can safely perform for assessment of physical functional capacity in patients with HCM. VO2max is the most common performance measurement evaluated in functional studies, showing higher values in those based on cycle-ergometer compared to treadmill. Subgroup analysis shows that exercise intolerance seems to be more related to age, medication and comorbidities than HCM phenotype itself. Lower VO2max is consistently seen in HCM patients at major cardiovascular risk.
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Affiliation(s)
- Adrián Bayonas-Ruiz
- Human Physiology Area, Faculty of Sport Sciences, University of Murcia, Santiago de la Ribera-San Javier, 30720 Murcia, Spain
| | | | - Vicente Ferrer
- Physiotherapy Department, Faculty of Medicine, Campus of Espinardo, University of Murcia, 30100 Murcia, Spain
| | - Carlos Pérez-Caballero
- Sports Activities Service, Campus of Espinardo, University of Murcia, 30100 Murcia, Spain
| | - María Sabater-Molina
- Inherited Cardiopathies Unit, Virgen de la Arrixaca University Hospital, El Palmar, 30120 Murcia, Spain
| | - María Teresa Tomé-Esteban
- Cardiovascular Clinical Academic Group, Inherited Cardiovascular Disease Unit, St George's Hospital NHS Foundation Trust, St George's University of London, London SW17 0QT, UK
| | - Bárbara Bonacasa
- Human Physiology Area, Faculty of Sport Sciences, University of Murcia, Santiago de la Ribera-San Javier, 30720 Murcia, Spain
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11
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Value of Exercise Stress Echocardiography in Children with Hypertrophic Cardiomyopathy. J Am Soc Echocardiogr 2020; 33:888-894.e2. [PMID: 32279939 DOI: 10.1016/j.echo.2020.01.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Exercise stress echocardiography (ESE) is a valuable diagnostic and prognostic tool in adults with hypertrophic cardiomyopathy (HCM). Inducible and resting left ventricular outflow tract gradients are important predictors of heart failure. However, there are minimal data on the utility of this modality in children. METHODS Retrospective review of all pediatric HCM patients who underwent ESE at Boston Children's Hospital (January 2007-June 2018) was carried out. Patients were assigned to one of three categories based on left ventricular outflow tract gradients: group 1: <30 mm Hg at rest and exercise; group 2: <30 mm Hg at rest and ≥30 mm Hg with exercise; and group 3: ≥ 30 mm Hg at rest and exercise. Records were reviewed for earliest occurrence of composite endpoint of any one of the following: cardiac syncope, chest pain, nonsustained and sustained ventricular tachycardia, aborted cardiac arrest, heart failure class ≥ II, or HCM-related death/transplantation. RESULTS A total of 91 children (67% males) with median age 12 years (6-24 years) at first ESE and median left ventricle wall thickness of 20 mm formed the cohort. Median follow-up duration was 3 years. During ESE, only one child experienced an event and was resuscitated. Of the 91 children, 25 were classified as group 1, 40 as group 2, and 26 as group 3. Twenty-six patients met the composite endpoint, including two heart transplant, one aborted cardiac arrest, and one sudden cardiac death. Group 3 patients had a 5 times higher risk of developing symptoms and/or serious clinical outcome at any age (hazard ratio = 5.18; 95% CI, [1.39-19.2]; P = .014). During our short follow-up time, group 2 patients had a higher risk of outcome, but this did not achieve statistical significance (hazard ratio = 1.95; 95% CI, [0.5-7.6]; P = .33). CONCLUSIONS In this large series of pediatric patients with HCM, ESE can be performed safely and served as an effective tool to identify the lowest risk patients for cardiac outcome.
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12
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Dasgupta S, Friedman H, Allen N, Stark M, Ferguson E, Sachdeva R, Border WL. Exercise stress echocardiography: Impact on clinical decision-making in pediatric patients. Echocardiography 2019; 36:938-943. [PMID: 30934142 DOI: 10.1111/echo.14326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/21/2019] [Accepted: 03/06/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The role of exercise stress echocardiography (ESE) in the pediatric population is less well defined as compared to adults. We aimed to determine the utility and impact of ESE on clinical decision-making in pediatric patients. METHODS We identified patients who underwent an ESE at our center from 2011 to 2015. Test indications were categorized into symptoms with exercise; sports/activity clearance; hypertrophic cardiomyopathy (HCM) or suspected HCM; coronary anomalies; or abnormal electrocardiogram (EKG). Change in clinical management was assessed by comparing pre- and post-test activity restrictions, which were categorized into unrestricted from exercise or activity; restricted from exercise or activity; and surgical referral. RESULTS During the study period, 353 ESEs met inclusion criteria. Of all ESEs performed, 263 (75%) were normal. Clinical management changed as a result of ESE in 144 (40%). Of the abnormal ESEs, 44 were restricted from activity, including 25 (56.8%) restricted from competitive or varsity athletics, 14 (31.8%) restricted from recreational sports, and 5 (11.4%) restricted from all activity. Surgical referrals included valve repair/replacement in 7 (50%), ICD placement in 5 (35.8%), coronary re-implantation in 1 (7.1%), and atrial septal defect repair in 1 (7.1%). CONCLUSION Exercise stress echocardiography provides the pediatric cardiologist with useful information that impacts management in a wide variety of cardiac disorders. Clinical management changed in nearly half the patients that were subjected to an ESE at our center. This supports the value of ESE for informing clinical decision-making. Future studies should aim to refine patient selection and examine its impact on patient outcomes.
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Affiliation(s)
- Soham Dasgupta
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | | | - Nicole Allen
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Megan Stark
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Eric Ferguson
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Ritu Sachdeva
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - William L Border
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
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13
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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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14
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Surgical Approaches to Hypertrophic Cardiomyopathy and Implications for Perioperative Management. Int Anesthesiol Clin 2018; 56:47-63. [PMID: 30204607 DOI: 10.1097/aia.0000000000000203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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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: 90] [Impact Index Per Article: 15.0] [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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16
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Vergé MP, Cochet H, Reynaud A, Morlon L, Peyrou J, Vincent C, Rooryck C, Ritter P, Lafitte S, Réant P. Characterization of hypertrophic cardiomyopathy according to global, regional, and multi-layer longitudinal strain analysis, and prediction of sudden cardiac death. Int J Cardiovasc Imaging 2018; 34:1091-1098. [PMID: 29488042 DOI: 10.1007/s10554-018-1323-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/22/2018] [Indexed: 01/24/2023]
Abstract
To evaluate the severity of hypertrophic cardiomyopathy (HCM) according to global, regional, and multi-layer longitudinal strain (LS) analysis using speckle-tracking echocardiography. From February 2007 to November 2014, we prospectively evaluated 375 consecutive HCM patients referred to our specialized cardiomyopathy center. Demographics, clinical, and rest and exercise echocardiographic parameters were collected according to a completely standardized protocol. Global, regional, and multilayer strain analyses were performed. Correlations between LS and other characteristics were evaluated, and we assessed their prognostic value to predict sudden cardiac death (SCD) or appropriate implantable cardioverter defibrillator (ICD) shocks during follow-up, using Cox proportional hazards analyses. We finally included 217 patients (50.1 ± 15.6 years, 67% male) but only 179 (82%) had LS analysis of sufficient quality. An inverse relation was observed between the mean basal left ventricular (LV) LS and diastolic parameters [E/Ea (r = - 0.30) and left atrium indexed volume (r = - 0.23)], as well as between the resting LV outflow-tract maximal gradient (r = - 0.26) or during peak exercise (r = - 0.20). Mean LS in the LV hypertrophic area was particularly related with maximal wall thickness (r = - 0.47) and transmural global LS with the degree of myocardial fibrosis in cardiac magnetic resonance (r = - 0.32). During a median follow-up of 2.8 ± 1.5 years, mean transmural LS in the hypertrophic area was predictor of SCD and appropriate ICD shock (10 events/179 patients, hazard ratio = 0.83 [95% CI 0.72-0.95], p = 0.01). Basal LS and hypertrophic area LS are valuable parameters to evaluate HCM severity. Mean hypertrophic area LS particularly seems predictive of SCD occurrence and appropriate ICD shocks.
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Affiliation(s)
| | - Hubert Cochet
- Bordeaux University Hospital, 33000, Bordeaux, France.,University of Bordeaux, 33000, Bordeaux, France.,IHU Lyric, 33600, Pessac, France
| | - Amélie Reynaud
- Bordeaux University Hospital, 33000, Bordeaux, France.,University of Bordeaux, 33000, Bordeaux, France
| | - Lucas Morlon
- Bordeaux University Hospital, 33000, Bordeaux, France.,University of Bordeaux, 33000, Bordeaux, France
| | - Jérôme Peyrou
- Bordeaux University Hospital, 33000, Bordeaux, France.,University of Bordeaux, 33000, Bordeaux, France
| | - Cécile Vincent
- Bordeaux University Hospital, 33000, Bordeaux, France.,University of Bordeaux, 33000, Bordeaux, France
| | - Caroline Rooryck
- Bordeaux University Hospital, 33000, Bordeaux, France.,University of Bordeaux, 33000, Bordeaux, France.,IHU Lyric, 33600, Pessac, France
| | - Philippe Ritter
- Bordeaux University Hospital, 33000, Bordeaux, France.,University of Bordeaux, 33000, Bordeaux, France.,IHU Lyric, 33600, Pessac, France
| | - Stéphane Lafitte
- Bordeaux University Hospital, 33000, Bordeaux, France.,University of Bordeaux, 33000, Bordeaux, France.,IHU Lyric, 33600, Pessac, France
| | - Patricia Réant
- Bordeaux University Hospital, 33000, Bordeaux, France. .,University of Bordeaux, 33000, Bordeaux, France. .,IHU Lyric, 33600, Pessac, France. .,Hopital Cardiologique Haut-Leveque, Avenue de Magellan, 33604, Pessac, France.
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17
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Ayoub C, Geske JB, Larsen CM, Scott CG, Klarich KW, Pellikka PA. Comparison of Valsalva Maneuver, Amyl Nitrite, and Exercise Echocardiography to Demonstrate Latent Left Ventricular Outflow Obstruction in Hypertrophic Cardiomyopathy. Am J Cardiol 2017; 120:2265-2271. [PMID: 29054275 DOI: 10.1016/j.amjcard.2017.08.047] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/23/2017] [Accepted: 08/25/2017] [Indexed: 12/21/2022]
Abstract
Guidelines recommend exercise stress echocardiogram (ESE) for patients with hypertrophic cardiomyopathy (HC) if a 50 mm Hg gradient is not present at rest or provoked with Valsalva or amyl nitrite, to direct medical and surgical management. However, no study has directly compared all 3 methods. We sought to evaluate efficacy and degree of provocation of left ventricular outflow gradients by ESE, and compare with Valsalva and amyl nitrite. In patients with HC between 2002 and 2015, resting echocardiograms and ESEs within 1 year were retrospectively reviewed. Gradients elicited by each provocation method were compared. Rest and ESE were available in 97 patients (mean age 54 ± 18 years, 57% male); 78 underwent Valsalva maneuver and 41 amyl nitrite provocation. Median gradients (interquartile range) were 10 mm Hg (7,19) at rest, 16 mm Hg (9,34) with Valsalva, 23 mm Hg (13,49) with amyl nitrite, and 26 mm Hg (13,58) with ESE. ESE and amyl nitrite were able to provoke obstruction (≥30 mm Hg) and severe obstruction (≥50 mm Hg) more frequently than Valsalva. In patients with resting gradient <30 mm Hg (n = 83), provocation maneuvers demonstrated dynamic obstruction in 51%; in those with Valsalva gradient <30 mm Hg (n = 57), ESE or amyl nitrite provoked a gradient in 44%; and in those with amyl nitrite gradient <30 mm Hg (n = 20), ESE provoked a gradient in 29%. No demographic or baseline echocardiographic parameter predicted provocable obstruction. In conclusion, ESE is clinically useful; however, different provocation maneuvers may be effective in different patients with HC, and all maneuvers may be required to provoke dynamic obstruction in symptomatic patients.
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Affiliation(s)
- Chadi Ayoub
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jeffrey B Geske
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Carolyn M Larsen
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Kyle W Klarich
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Patricia A Pellikka
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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18
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Moneghetti KJ, Stolfo D, Christle JW, Kobayashi Y, Finocchiaro G, Sinagra G, Myers J, Ashley EA, Haddad F, Wheeler MT. Value of Strain Imaging and Maximal Oxygen Consumption in Patients With Hypertrophic Cardiomyopathy. Am J Cardiol 2017; 120:1203-1208. [PMID: 28802509 DOI: 10.1016/j.amjcard.2017.06.070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 06/14/2017] [Accepted: 06/30/2017] [Indexed: 10/19/2022]
Abstract
Longitudinal strain (LS) has been shown to be predictive of outcome in hypertrophic cardiomyopathy (HC). Percent predicted peak oxygen uptake (ppVO2), among other cardiopulmonary exercise testing (CPX) metrics, is a strong predictor of prognosis in HC. However, there has been limited investigation into the combination of LS and CPX metrics. This study sought to determine how LS and parameters of exercise performance contribute to prognosis in HC. One hundred and thirty-one consecutive patients with HC who underwent CPX and stress echocardiography were included. Global, septal, and lateral LS were assessed at rest and stress. Eighty matched individuals were used as controls. Patients were followed for the composite end point of death and worsening heart failure. All absolute LS components were lower in patients with HC than in controls (global 14.3 ± 4.0% vs 18.8 ± 2.2%, p <0.001; septal 11.9 ± 4.9% vs 17.9 ± 2.7%, p <0.001; lateral 16.0 ± 4.7% vs 19.4 ± 3.1%, p = 0.001). Global strain reserve was also reduced in patients with HC (13 ± 5% vs 19 ± 8%, p = 0.002). Over a median follow-up of 56 months (interquartile range 14 to 69), the composite end point occurred in 53 patients. Global LS was predictive of outcome on univariate analysis (0.55 [0.41 to 0.74], p <0.001). When combined with CPX metrics, lateral LS was the only strain variable predictive of outcome along with indexed left atrial volume (LAVI) and ppVO2. The worst outcomes were observed for patients with lateral LS <16.1%, LAVI >52 ml/m2, and ppVO2 <80%. The combination of lateral LS, LAVI, and ppVO2 presents a simple model for outcome prediction.
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19
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Tower-Rader A, Betancor J, Lever HM, Desai MY. A Comprehensive Review of Stress Testing in Hypertrophic Cardiomyopathy: Assessment of Functional Capacity, Identification of Prognostic Indicators, and Detection of Coronary Artery Disease. J Am Soc Echocardiogr 2017; 30:829-844. [DOI: 10.1016/j.echo.2017.05.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Indexed: 01/17/2023]
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20
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Hiemstra YL, Debonnaire P, Bootsma M, van Zwet EW, Delgado V, Schalij MJ, Atsma DE, Bax JJ, Marsan NA. Global Longitudinal Strain and Left Atrial Volume Index Provide Incremental Prognostic Value in Patients With Hypertrophic Cardiomyopathy. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005706. [PMID: 28679523 DOI: 10.1161/circimaging.116.005706] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 05/09/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Current methods for predicting adverse events in patients with hypertrophic cardiomyopathy are still limited. Left ventricular global longitudinal strain (GLS) and left atrial volume index (LAVI) have been recently proposed as novel prognostic factors in several cardiovascular diseases. The objective of this study was to evaluate the prognostic value of GLS and LAVI in patients with hypertrophic cardiomyopathy. METHODS AND RESULTS Two-dimensional echocardiography was performed in 427 patients with hypertrophic cardiomyopathy (66% men, age 52±15 years), and LAVI and GLS were assessed. During follow-up, the primary end point of all-cause mortality, heart transplantation, sudden cardiac death, and appropriate implantable cardioverter defibrillator therapy was noted. A total of 103 patients reached the primary end point during a follow-up of 6.7 (interquartile range, 3.3-10.0) years. Multivariable Cox regression analysis revealed GLS and LAVI to be independently associated with the primary end point (hazard ratio GLS, 1.10 [1.03-1.19], P=0.007; hazard ratio LAVI, 4.27 [2.35-7.74], P<0.001) after correcting for other clinical variables. When applying the pre-specified cut-off values of 34 mL/m2 for LAVI and -15% for GLS, Kaplan-Meier survival curves showed significant better survival for patients with LAVI <34 mL/m2 (P<0.001) and GLS <-15% (P<0.001) as compared with their counterparts. The likelihood ratio test showed a significant incremental prognostic value of LAVI and GLS (P<0.001) as compared with a model with clinical and standard echocardiographic risk factors. The C-statistic for this model increased from 0.68 to 0.73 when adding GLS and LAVI. CONCLUSIONS GLS and LAVI are independently associated with adverse outcome in patients with hypertrophic cardiomyopathy and may help to optimize risk stratification in these patients.
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Affiliation(s)
- Yasmine L Hiemstra
- From the Departments of Cardiology (Y.L.H., P.D., M.B., V.D., M.J.S., D.E.A., J.J.B., N.A.M.) and Medical Statistics (E.W.v.Z.), Leiden University Medical Center, The Netherlands
| | - Philippe Debonnaire
- From the Departments of Cardiology (Y.L.H., P.D., M.B., V.D., M.J.S., D.E.A., J.J.B., N.A.M.) and Medical Statistics (E.W.v.Z.), Leiden University Medical Center, The Netherlands
| | - Marianne Bootsma
- From the Departments of Cardiology (Y.L.H., P.D., M.B., V.D., M.J.S., D.E.A., J.J.B., N.A.M.) and Medical Statistics (E.W.v.Z.), Leiden University Medical Center, The Netherlands
| | - Erik W van Zwet
- From the Departments of Cardiology (Y.L.H., P.D., M.B., V.D., M.J.S., D.E.A., J.J.B., N.A.M.) and Medical Statistics (E.W.v.Z.), Leiden University Medical Center, The Netherlands
| | - Victoria Delgado
- From the Departments of Cardiology (Y.L.H., P.D., M.B., V.D., M.J.S., D.E.A., J.J.B., N.A.M.) and Medical Statistics (E.W.v.Z.), Leiden University Medical Center, The Netherlands
| | - Martin J Schalij
- From the Departments of Cardiology (Y.L.H., P.D., M.B., V.D., M.J.S., D.E.A., J.J.B., N.A.M.) and Medical Statistics (E.W.v.Z.), Leiden University Medical Center, The Netherlands
| | - Douwe E Atsma
- From the Departments of Cardiology (Y.L.H., P.D., M.B., V.D., M.J.S., D.E.A., J.J.B., N.A.M.) and Medical Statistics (E.W.v.Z.), Leiden University Medical Center, The Netherlands
| | - Jeroen J Bax
- From the Departments of Cardiology (Y.L.H., P.D., M.B., V.D., M.J.S., D.E.A., J.J.B., N.A.M.) and Medical Statistics (E.W.v.Z.), Leiden University Medical Center, The Netherlands
| | - Nina Ajmone Marsan
- From the Departments of Cardiology (Y.L.H., P.D., M.B., V.D., M.J.S., D.E.A., J.J.B., N.A.M.) and Medical Statistics (E.W.v.Z.), Leiden University Medical Center, The Netherlands.
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Reant P, Lafitte S, Reynaud A. How to perform stress/exercise echocardiography in -hypertrophic cardiomyopathy? Acta Cardiol 2017. [PMID: 28636508 DOI: 10.1080/00015385.2017.1304754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Patricia Reant
- Bordeaux University, Bordeaux, France
- University Hospital Centre of Bordeaux, Bordeaux, France
- INSERM U1045, Pessac, France
- IHU Liryc, Pessac, France
- CIC plurithematique 1401, Pessac, France
| | - Stephane Lafitte
- Bordeaux University, Bordeaux, France
- University Hospital Centre of Bordeaux, Bordeaux, France
- IHU Liryc, Pessac, France
- CIC plurithematique 1401, Pessac, France
- INSERM U1034, Pessac, France
| | - Amelie Reynaud
- Bordeaux University, Bordeaux, France
- University Hospital Centre of Bordeaux, Bordeaux, France
- CIC plurithematique 1401, Pessac, France
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Exercise stress echocardiography in hypertrophic cardiomyopathy. J Echocardiogr 2017; 15:110-117. [PMID: 28501918 DOI: 10.1007/s12574-017-0338-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 04/19/2017] [Accepted: 04/28/2017] [Indexed: 01/06/2023]
Abstract
In this review, we make a comprehensive summary of exercise stress echocardiography in hypertrophic cardiomyopathy (HCM) and practical tips used in our hospital. The main objective of performing exercise stress echocardiography in patients with HCM is to evaluate left ventricular outflow tract obstruction, mitral regurgitation, left ventricular asynergy, and diastolic function during exercise. There are limitations to the explanations that can be provided for exertional symptoms when resting echocardiography is performed in patients with HCM. In contrast, exercise stress echocardiography causes the manifestation of findings that are latent at rest, which possibly provides the elucidation of symptom etiology. In this article, we focus on the usefulness of exercise stress echocardiography in HCM.
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Bayrak F, Kahveci G, Buturak A, Karaahmet T, Batgerel U, Koyuncu A, Mutlu B. Value of latent outflow obstruction to predict clinical course of patients with hypertrophic cardiomyopathy. Acta Cardiol 2017; 72:172-179. [PMID: 28597791 DOI: 10.1080/00015385.2017.1291155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective The frequency, significance and prognostic value of left ventricle obstruction (LVO) induced with provocation (latent LVO) is controversial for hypertrophic cardiomyopathy (HC) patients. This study was designed to assess the value of latent LVO in predicting the clinical course in 101 patients with HC. Methods and results Patients were followed for a mean of 82 ± 48 months (range 2 to 148 months) for clinical end points defined as a composite of cardiovascular death resuscitated cardiac arrest, appropriate defibrillator shock or hospitalization due to worsening of heart failure symptoms. Presence of LVO (hazard ratio 3.63; 95% confidence interval, 1.85 to 7.12; P = 0.0001) and log NT-proBNP levels (hazard ratio, 1.40; 95% confidence interval, 1.14 to 1.72; P = 0.001) were the independent variables associated with an increased risk of experiencing clinical end points. HC patients with latent LVO have a trend toward decreased survival when compared with HC patients without LVO (log rank P = 0.027), but better survival than patients with resting LVO (log rank P = 0.007). HC patients with NT-proBNP levels <1,000 pg/ml had also better survival. LVO and NT-proBNP levels are the major determinants of clinical end points in patients with HC. Conclusions Evaluation of patients without resting LVO to demonstrate latent obstruction is of critical importance in respect of outcome and selection of patients for septal reduction therapies, so routine provocative testing with physiological exercise and measurement of NT-proBNP is recommended in this patient population for risk stratification.
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Affiliation(s)
- Fatih Bayrak
- Department of Cardiology, Acibadem University, Istanbul, Turkey
| | - Gokhan Kahveci
- Department of Cardiology, Kosuyolu Heart and Research Hospital, Istanbul, Turkey
| | - Ali Buturak
- Department of Cardiology, Acibadem University, Istanbul, Turkey
| | - Tansu Karaahmet
- Department of Cardiology, Acibadem University, Istanbul, Turkey
| | | | - Atilla Koyuncu
- Bakırkoy Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Bulent Mutlu
- Department of Cardiology, Marmara University, Istanbul, Turkey
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24
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Xu HY, Chen J, Yang ZG, Li R, Shi K, Zhang Q, Liu X, Xie LJ, Jiang L, Guo YK. Early marker of regional left ventricular deformation in patients with hypertrophic cardiomyopathy evaluated by MRI tissue tracking: The effects of myocardial hypertrophy and fibrosis. J Magn Reson Imaging 2017; 46:1368-1376. [PMID: 28370909 DOI: 10.1002/jmri.25681] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 02/07/2017] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To evaluate the regional left ventricular (LV) myocardial strain of early stage hypertrophic cardiomyopathy (HCM) patients by magnetic resonance (MR) tissue tracking. MATERIALS AND METHODS In all, 114 adult HCM patients classified as NYHA I or II and 32 healthy volunteers were enrolled and underwent 3.0T MR examination. Vertical 2-chamber long axis, horizontal 4-chamber, and short axis cine sequence as well as late gadolinium enhancement images (LGE) were scanned. The cardiac function, regional LV tissue tracking variables, end-diastolic wall thickness (EDTH), and LGE extent were measured. RESULTS In the HCM group, 38 were NYHA I and 76 were NYHA II. By regional analysis, peak strain (PS) and peak displacement (PD) with radial, circumferential direction of hypertrophic segments (n = 283) were significantly lower than nonhypertrophic segments (n = 1541) (all P < 0.05). Radial PS was significantly correlated with LVEDTH (r = -0.467, P < 0.0001). Radial PD was negatively associated with LVEDTH (r = -0.331, P < 0.0001). The PS and PD of all directions were decreased in segments with LGE (n = 723) compared with those without LGE (n = 1101) (all P < 0.05). In addition, radial PS and PD were negatively associated with LGE extent (radial PS, r = -0.441; radial PD, r = -0.274; both P < 0.0001). All strain parameters showed excellent inter- and intraobserver agreements. CONCLUSION Decreased regional LV myocardial strain hypertrophic and fibrotic segments of early-stage HCM patients can be measured by MR tissue tracking based on routine cine images. Moreover, myocardial strain may decrease with the increasing of myocardial hypertrophy as well as fibrosis. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1368-1376.
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Affiliation(s)
- Hua-Yan Xu
- Department of Radiology, National Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Sichuan, P.R. China
| | - Jing Chen
- Department of Radiology, National Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Sichuan, P.R. China.,Department of Radiology, Affiliated Hospital of Southwest Medical University, Sichuan, P.R. China
| | - Zhi-Gang Yang
- Department of Radiology, National Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Sichuan, P.R. China
| | - Rui Li
- Department of Radiology, National Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Sichuan, P.R. China
| | - Ke Shi
- Department of Radiology, National Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Sichuan, P.R. China
| | - Qin Zhang
- Department of Radiology, National Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Sichuan, P.R. China
| | - Xi Liu
- Department of Radiology, National Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Sichuan, P.R. China
| | - Lin-Jun Xie
- Department of Radiology, National Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Sichuan, P.R. China
| | - Li Jiang
- Department of Radiology, National Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Sichuan, P.R. China
| | - Ying-Kun Guo
- Department of Radiology, West China Second University Hospital, Sichuan University, Sichuan, P.R. China
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25
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Reant P, Dufour M, Peyrou J, Reynaud A, Rooryck C, Dijos M, Vincent C, Cornolle C, Roudaut R, Lafitte S. Upright treadmill vs. semi-supine bicycle exercise echocardiography to provoke obstruction in symptomatic hypertrophic cardiomyopathy: a pilot study. Eur Heart J Cardiovasc Imaging 2017; 19:31-38. [DOI: 10.1093/ehjci/jew313] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 11/28/2016] [Indexed: 02/06/2023] Open
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26
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Lancellotti P, Pellikka PA, Budts W, Chaudhry FA, Donal E, Dulgheru R, Edvardsen T, Garbi M, Ha JW, Kane GC, Kreeger J, Mertens L, Pibarot P, Picano E, Ryan T, Tsutsui JM, Varga A. The Clinical Use of Stress Echocardiography in Non-Ischaemic Heart Disease: Recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr 2017; 30:101-138. [DOI: 10.1016/j.echo.2016.10.016] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Collier P, Phelan D, Klein A. A Test in Context: Myocardial Strain Measured by Speckle-Tracking Echocardiography. J Am Coll Cardiol 2017; 69:1043-1056. [DOI: 10.1016/j.jacc.2016.12.012] [Citation(s) in RCA: 280] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 11/28/2016] [Accepted: 12/04/2016] [Indexed: 12/22/2022]
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28
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Lancellotti P, Pellikka PA, Budts W, Chaudhry FA, Donal E, Dulgheru R, Edvardsen T, Garbi M, Ha JW, Kane GC, Kreeger J, Mertens L, Pibarot P, Picano E, Ryan T, Tsutsui JM, Varga A. The clinical use of stress echocardiography in non-ischaemic heart disease: recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2016; 17:1191-1229. [DOI: 10.1093/ehjci/jew190] [Citation(s) in RCA: 206] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 08/12/2016] [Indexed: 12/20/2022] Open
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Claus P, Omar AMS, Pedrizzetti G, Sengupta PP, Nagel E. Tissue Tracking Technology for Assessing Cardiac Mechanics: Principles, Normal Values, and Clinical Applications. JACC Cardiovasc Imaging 2016; 8:1444-1460. [PMID: 26699113 DOI: 10.1016/j.jcmg.2015.11.001] [Citation(s) in RCA: 302] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/06/2015] [Indexed: 02/06/2023]
Abstract
Tissue tracking technologies such as speckle tracking echocardiography and feature tracking cardiac magnetic resonance have enhanced the noninvasive assessment of myocardial deformation in clinical research and clinical practice. The widespread enthusiasm for using tissue tracking techniques in research and clinical practice stems from the ready applicability of these technologies to routine echocardiographic or cardiac magnetic resonance images. The technology is common to both modalities, and derived parameters to describe myocardial mechanics are the similar, albeit with different accuracies. We provide an overview of the normal values and reproducibility of the clinically applicable parameters, together with their clinical validation. The use of these technologies in different clinical scenarios, and the additive value to current imaging diagnostics are discussed.
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Affiliation(s)
- Piet Claus
- Laboratory for Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Alaa Mabrouk Salem Omar
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Internal Medicine, Medical Division, National Research Centre, Dokki, Cairo, Egypt
| | - Gianni Pedrizzetti
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Partho P Sengupta
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eike Nagel
- Institute of Cardiovascular Imaging, Goethe University Frankfurt and German Centre for Cardiovascular Research ([DZHK], partner site Rhine-Main), Frankfurt, Germany.
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Long mitral valve leaflets determine left ventricular outflow tract obstruction during exercise in hypertrophic cardiomyopathy. Int J Cardiol 2016; 212:47-53. [DOI: 10.1016/j.ijcard.2016.03.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 03/04/2016] [Accepted: 03/13/2016] [Indexed: 11/22/2022]
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Kalra A, Harris KM, Maron BA, Maron MS, Garberich RF, Haas TS, Lesser JR, Maron BJ. Relation of Doppler Tissue Imaging Parameters With Heart Failure Progression in Hypertrophic Cardiomyopathy. Am J Cardiol 2016; 117:1808-14. [PMID: 27089980 DOI: 10.1016/j.amjcard.2016.03.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/11/2016] [Accepted: 03/11/2016] [Indexed: 11/27/2022]
Abstract
Refractory progressive heart failure (HF) is becoming the predominant cause of mortality in nonobstructive hypertrophic cardiomyopathy (HC). To anticipate development of this important and often unpredictable clinical course, we investigated whether left ventricular diastolic dysfunction, assessed by echocardiographic Doppler parameters, could identify a subset of patients with HC without obstruction at rest who would experience progression of HF. Diastolic function parameters, assessed by Doppler tissue imaging (DTI), mitral inflow, and pulmonary venous flow were measured in 274 consecutive adult patients with HC evaluated from 2003 to 2007. DTI and other diastolic and clinical/demographic parameters were measured against the composite end point of HF/death, heart transplantation, or progression to advanced New York Heart Association functional class III/IV symptoms and sudden death (SD)/implantable defibrillator (ICD) interventions. HF end points were reached in 19 of 274 patients (7%) over a follow-up period of 4.0 ± 2.3 years. Variables significantly associated with HF outcome by univariate analysis included male gender, initial New York Heart Association class II, lower ejection fraction, and reduced septal and lateral e' mitral annular tissue velocities. Multivariable analysis showed only a reduced lateral e' mitral annular tissue velocity to be independently associated with the composite HF end points (HR 0.77; 95% CI 0.65 to 0.91; p = 0.003). In addition, estimated pulmonary arterial systolic pressure and extensive late gadolinium enhancement by magnetic resonance were also associated with HF outcome (p = 0.04 and p <0.001, respectively). No Doppler (or clinical) variable was associated with SD/appropriate ICD interventions. In conclusion, in HC without outflow obstruction at rest, diastolic dysfunction, evidenced by DTI-reduced lateral e' mitral annular tissue velocity, was associated with adverse long-term HF outcome but was unrelated to SD. This echocardiographic marker provides a potential noninvasive strategy for anticipating progressive HF in this HC patient group.
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Abstract
PURPOSE OF REVIEW The present article reviews the recent advances in the echocardiographic assessment of left ventricular outflow tract (LVOT) obstruction in hypertrophic cardiomyopathy (HCM). In particular, it highlights the role of novel imaging techniques in promoting our understanding of the pathophysiology of obstruction and discusses the prognostic value of information obtained from exercise echocardiography and the emerging role of image-guidance technologies for interventional relief of obstruction. RECENT FINDINGS The advent of novel echocardiography technologies, such as vector flow mapping, continues to expand our understanding of the exact mechanism of systolic anterior motion leading to dynamic LVOT obstruction by providing new insights into the interaction between pathologic mitral geometry and the left ventricular flow field. New studies provide evidence for the prognostic value of exercise echocardiography in the assessment of patients with HCM. Myocardial contrast perfusion imaging can delineate the anatomy of septal perforator arteries and identify the downstream septal perfusion bed, which is critical for safely guiding the procedure of alcohol septal ablation. SUMMARY Echocardiography represents a versatile, continuously evolving, and easily repeatable technique, allowing truly dynamic imaging studies, and is therefore most appropriate to evaluate a dynamic disease condition such as LVOT obstruction in HCM. It provides profound insights into the pathophysiology of LVOT obstruction, information on its clinical impact, and guidance for its relief by interventional strategies.
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Reant P, Mirabel M, Lloyd G, Peyrou J, Lopez Ayala JM, Dickie S, Bulluck H, Captur G, Rosmini S, Guttmann O, Demetrescu C, Pantazis A, Tome-Esteban M, Moon JC, Lafitte S, McKenna WJ. Global longitudinal strain is associated with heart failure outcomes in hypertrophic cardiomyopathy. Heart 2016; 102:741-7. [PMID: 26857213 DOI: 10.1136/heartjnl-2015-308576] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 01/08/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE We hypothesised that abnormal global longitudinal strain (GLS) would predict outcome in hypertrophic cardiomyopathy (HCM) better than current echocardiographic measures. METHODS Retrospective analysis of risk markers in relation to outcomes in 472 patients with HCM at a single tertiary institution (2006-2012). Exclusion criteria were left ventricular (LV) hypertrophy of other origin, patients in atrial fibrillation, lost to follow-up and insufficient image quality to perform strain analysis. Standardised echocardiogram recordings were reviewed and standard variables and LV GLS were measured. The primary end-point included all cardiac deaths, appropriate defibrillator shocks and heart failure (HF) admissions. The secondary end-point was death by HF and admissions related to HF. RESULTS Mean age was 50.0±15.0 years; 322 (68%) were men. At a median of 4.3 years (IQR 0.1-7.8) follow-up, 21 (4.4%) patients experienced cardiovascular death: 6 (1.3%) died from HF, 13 (2.7%) had sudden cardiac death and 2 (0.4%) died secondary to stroke. Four (0.8%) patients experienced appropriate defibrillator shock, and 13 (2.7%) were admitted for HF. On multivariate Fine-Gray proportional hazard analyses, GLS was significantly associated with the primary end-point (HR=0.90, 95% CI 0.83 to 0.98, p=0.018) independently of age, maximal provoked LV outflow-tract gradient and LV end-systolic volume. Moreover, GLS was particularly associated with the secondary end-point (HR=0.82, 95% CI 0.75 to 0.90, p<0.0001) independently of age, previous atrial fibrillation, New York Heart Association (NYHA) class III-IV, LV end-systolic volume, E/E', and outflow-tract gradient. Survival curves confirmed that GLS was associated with HF events (GLS <15.6%, p=0.0035). CONCLUSIONS In patients with HCM, reduced GLS is an independent factor associated with poor cardiac outcomes, and particularly HF outcomes.
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Affiliation(s)
- Patricia Reant
- Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK University of Bordeaux, CHU de Bordeaux, Bordeaux, France
| | - Mariana Mirabel
- Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Guy Lloyd
- Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK
| | - Jérôme Peyrou
- University of Bordeaux, CHU de Bordeaux, Bordeaux, France
| | - Jose-Maria Lopez Ayala
- Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK
| | - Shaughan Dickie
- Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK
| | - Heeraj Bulluck
- Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK
| | - Gabriella Captur
- Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK
| | - Stefania Rosmini
- Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK
| | - Oliver Guttmann
- Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK
| | - Camelia Demetrescu
- Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK
| | - Antonis Pantazis
- Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK
| | - Maite Tome-Esteban
- Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK
| | - James C Moon
- Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK
| | | | - William J McKenna
- Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK
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Abstract
Determination of ventricular arrhythmic risk is crucial for guiding management of cardiac disease. Although for patients at increased risk an implantable cardioverter-defibrillator is recommended, it is widely acknowledged that current criteria for device use based predominantly on left ventricular ejection fraction are deficient. Genesis of ventricular arrhythmias involves a complex interaction of myocardial substrate abnormalities, precipitating triggers, and modulating factors. There are much data showing that by more directly assessing these factors, noninvasive imaging using echocardiography, radionuclide imaging, and cardiac magnetic resonance enhances arrhythmic risk stratification beyond ejection fraction and commonly used electrocardiographic and serum biomarkers. It is anticipated that further technological advancements studied in well-designed clinical trials will provide both more precise determination of risk and guide therapies to enhanced survival and patient well-being.
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Affiliation(s)
- Mark I Travin
- From the Division of Nuclear Medicine, Department of Radiology (M.I.T.) and Division of Cardiology, Department of Medicine (C.C.T), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; and Metropolitan Heart and Vascular Institute, Minneapolis, MN (D.F.).
| | - DaLi Feng
- From the Division of Nuclear Medicine, Department of Radiology (M.I.T.) and Division of Cardiology, Department of Medicine (C.C.T), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; and Metropolitan Heart and Vascular Institute, Minneapolis, MN (D.F.)
| | - Cynthia C Taub
- From the Division of Nuclear Medicine, Department of Radiology (M.I.T.) and Division of Cardiology, Department of Medicine (C.C.T), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; and Metropolitan Heart and Vascular Institute, Minneapolis, MN (D.F.)
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35
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Abstract
Over the past decade, new echocardiographic techniques such as three-dimensional echocardiography and the imaging of myocardial deformation (strain) have been developed, and are increasingly used in clinical practice. In this article, we describe the rationale and methodology, review available guidelines for practice, and discuss the advantages and limitations of each of these modalities. When available, we have also summarised the scientific evidence for the clinical application of these techniques to detect heart failure in children.
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Chun S, Woo A. Echocardiography in Hypertrophic Cardiomyopathy: In with Strain, Out with Straining? J Am Soc Echocardiogr 2015; 28:204-9. [DOI: 10.1016/j.echo.2014.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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