Incremental Values of Cardiac Mechanics in Systolic and Diastolic Heart Failure in Hypertrophic Cardiomyopathy

Document Type: Original Article

Authors

1 Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

2 Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, IR Iran.

3 Heart Valve Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

Abstract

Background:The early diagnosis of heart failure in patients with hypertrophic cardiomyopathy (HCM) remains a challenge. In this study, we sought to evaluate cardiac mechanics in patients with HCM.
 
Methods:Sixty patients (60% men, mean age = 45.8 ± 17 y) with documented HCM were identified from an ongoing clinical registry.
 
Results:The values of maximal left ventricular (LV) wall thickness, the ejection fraction (EF), global the longitudinal strain (GLS), and the global circumferential strain (GCS) were 2.2 ± 0.5 cm, 54.1 ± 6.5%, −15.3 ± 4.5%, and −26.9 ± 7.5, consecutively. Cardiovascular magnetic resonance imaging (CMR) data on 34 patients were included in the analysis. Nearly half of the patients had obstructive HCM; and in comparison with nonobstructive HCM, there were no significant differences in terms of GLS, GCS, EF, and the New York Heart Association Functional Class (NYHA FC). EF was similar between the 2 NYHA FC groups (I and II vs III and IV). GLS had a meaningful difference between the NYHA FC groups. In patients with a late gadolinium enhancement (LGE) value of equal to or greater than 15%, EF, GLS, and GCS were correlated and reduced.  Additionally, in those with an LGE value of between 5% and 15%, EF was preserved with a reduced GLS. GLS was worse in patients with an E/average E′ ratio of equal to or greater than 14.
 
Conclusions:Our study showed that an increased LV wall thickness and/or a reduced LV end-diastolic volume, with better GCS, maintained a normal EF despite a reduced GLS. GLS had a better correlation with NYHA FC and LGE in CMR than EF alone. (Iranian Heart Journal 2020; 21(4): 43-59)
 

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