Role of global longitudinal strain in discriminating variant forms of left ventricular hypertrophy and predicting mortality

Echocardiographic Updates in the Assessment of Cardiomyopathy

PURPOSE OF REVIEW

This review aims to provide an updated overview of the role of echocardiography in the assessment of cardiomyopathies, highlighting recent findings and technological advancements.

RECENT FINDINGS

Over the past few years, significant advancements in echocardiographic techniques have improved diagnostic accuracy and provided important prognostic value in the assessment of cardiomyopathies. Cardiomyopathy is a group of diseases affecting the heart muscle. Echocardiography, a non-invasive imaging modality provides crucial information on cardiac structure, function, and hemodynamics. Recent advancements, including strain imaging, speckle-tracking, and 3D echocardiography enhance the precision of structural and functional assessments, while artificial intelligence integration improves diagnostic accuracy and workflow efficiency. These advancements not only refine diagnostic capabilities but also provide prognostic insights and facilitate better patient outcomes.

The role of diagnostic modalities in differentiating hypertensive heart disease and hypertrophic cardiomyopathy: strategies in adults for potential application in paediatrics

Hypertensive heart disease and hypertrophic cardiomyopathy both lead to left ventricular hypertrophy despite differing in aetiology. Elucidating the correct aetiology of the presenting hypertrophy can be a challenge for clinicians, especially in patients with overlapping risk factors. Furthermore, drugs typically used to combat hypertensive heart disease may be contraindicated for the treatment of hypertrophic cardiomyopathy, making the correct diagnosis imperative. In this review, we discuss characteristics of both hypertensive heart disease and hypertrophic cardiomyopathy that may enable clinicians to discriminate the two as causes of left ventricular hypertrophy. We summarise the current literature, which is primarily focused on adult populations, containing discriminative techniques available via diagnostic modalities such as electrocardiography, echocardiography, and cardiac MRI, noting strategies yet to be applied in paediatric populations. Finally, we review pharmacotherapy strategies for each disease with regard to pathophysiology.

Layer-specific proteomic profiling of human normal heart

BACKGROUND

The organized functioning of the anisotropic myocardial layers-including the inner longitudinal, middle circular, and outer longitudinal layers-is essential for stable systemic circulation. However, the proteomic profile of each myocardial layer has not been studied yet. Here, we aimed to elucidate the layer-specific proteomic profile of human cardiac tissue using microscopic sampling.

METHODS

Normal hearts were obtained from five autopsy cases, and cardiomyocytes were microdissected separately from the three myocardial layers of the left ventricle. Histological analysis and shotgun proteomic profiling were performed, followed by immunohistochemical analysis.

RESULTS

Histologically, no significant changes were observed among the three layers regarding cardiomyocyte diameter and myocardial fibrosis. Totally 1220 proteins-comprising 9404 peptides-were identified from 15 samples, of which the expression levels of 92 proteins were significantly altered among the layers. Gene ontology enrichment analysis revealed that the proteins specifically elevated in the inner and outer layers mostly belonged to the actin filament-binding protein group. In particular, MYH1 was highly expressed in cardiomyocytes in the outer layer, and CTNNA3 was highly expressed at the intercalated disc in the inner layer.

CONCLUSIONS

This is the first report on layer-specific proteomic profiling of human normal hearts. Anisotropic profiles of actin filament-binding proteins in myocardial layers may contribute to the anisotropic contractile and conductive abilities of the heart. Knowledge of the layer-specific proteome profiles of a human heart in the normal state can aid in further research on cardiac pathology, such as the prognosis and treatment of focal myocardial infarction.

Prevention and treatment of hypertensive left ventricular hypertrophy

PURPOSE OF REVIEW

Left ventricular (LV) hypertrophy (LVH) is a well recognized target organ adaptation to longstanding uncontrolled hypertension and other cardiovascular risk factors. It is also a strong and independent predictor of many cardiovascular disorders.

RECENT FINDINGS

This focused review explores the current concepts in screening, diagnosis, prevention, and treatment of LVH in patients with hypertension. Currently, the primary screening and diagnostic tools for LVH are ECG and 2D echocardiography. Implementing machine learning in the diagnostic modalities can improve sensitivity in the detection of LVH. Lifestyle modifications, blood pressure control with antihypertensive therapy, and management of comorbidities aid in preventing and reversing LV remodeling.

SUMMARY

LVH is a common and often silent complication of hypertension. Prevention and reversal of LV remodeling are crucial for cardiovascular risk reduction in patients with hypertension.

Hypertrophic cardiomyopathy: a modern view of the problem

Cardiomyopathy is considered one of the main causes of heart failure and sudden cardiac death, at least in young people. Approximately 50% of patients who die suddenly in childhood or adolescence or undergo heart transplantation suffer from this condition. The purpose of this literature review is to study and highlight the issues of etiology, pathogenesis, clinical features, diagnosis and treatment of hypertrophic cardiomyopathy from the point of view of modern ideas. The search and analysis of domestic and foreign literature materials using the PubMed and eLibrary databases was carried out. Of particular interest is the etiology of primary congenital cardiomyopathies, in respect of which research continues. As a result of the implementation of genetic factors, multiple structural and functional changes in the myocardium develop, which lead to changes in hemodynamics. Cardiomyopathy is a clinically heterogeneous disease, and one of the factors that determine the clinical phenotype is the genotype. In addition to standard laboratory testing, patients with suspected hypertrophic cardiomyopathy are advised to undergo medical genetic counseling to identify the causative mutation, and often to obtain prognostic information. The fundamental imaging method is echocardiography, but the role of magnetic resonance imaging in the diagnosis of the disease is also considered. Patients with symptomatic obstructive hypertrophic cardiomyopathy are usually recommended first-line pharmacotherapy with -blockers or non-dihydropyridine calcium channel blockers. Currently, research on new drugs for the treatment of hypertrophic cardiomyopathy inhibitors of cardiac myosin is ongoing. Surgical methods of treatment are developing progressively, however, methods of conservative treatment require further active research of drugs that have not been used before.

Assessment of papillary muscle free strain in hypertrophic cardiomyopathy and hypertension-induced left ventricular hypertrophy

OBJECTIVES

We aimed to evaluate and compare papillary muscle free strain in hypertrophic cardiomyopathy (HCMP) and hypertensive (HT) patients.

METHODS

Global longitudinal strain (GLS), and longitudinal myocardial strain of the anterolateral (ALPM) and posteromedial papillary muscles (PMPM) were obtained in 46 HCMP and 50 HT patients.

RESULTS

Interventricular septum (IVS)/posterior wall (PW) thickness ratio, left ventricular mass index (LVMI), left atrial anteroposterior diameter (LAAP) and mitral E/E' were found to be increased in patients with HCMP compared to HT patients. Left ventricular cavity dimensions were smaller in HCMP patients. GLS of HCMP and HT patients were - 14.52 ± 3.01 and -16.85 ± 1.36%, respectively (p < 0.001). Likewise, ALPM and PMPM free strain values were significantly reduced in HCMP patients over HT patients [-14.00% (-22 to -11%) and -15.5% (-24.02 to -10.16%) vs -23.00% (-24.99 to -19.01%) and -22.30% (-26.48 to -15.95%) (p = 0.016 and p = 0.010)], respectively. ALPM free strain showed a statistically significant correlation with GLS, maximal wall thickness, IVS thickness and LVMI. PMPM free strain showed a significant correlation with GLS, IVS thickness and LAAP. The GLS value of - 13.05 had a sensitivity of 61.9% and a specificity of 97.4% for predicting HCMP. ALPM and PMPM free strain values of -15.31 and -17.17% had 63 and 76.9% sensitivity and 85.7 and 76.9% specificity for prediction of HCMP.

CONCLUSIONS

Besides other echocardiographic variables, which were investigated in earlier studies, papillary muscle free strain also could be used in HCMP to distinguish HCMP- from HT-associated hypertrophy.