Reverse septal curvature in HCM patients is associated with LV aneurysm, intraventricular gradient, and adverse remodeling, marking a high-risk phenotype.
Is reverse septal curvature associated with high-risk clinical and imaging features in patients with hypertrophic cardiomyopathy?
Reverse septal curvature in hypertrophic cardiomyopathy is associated with LV aneurysms and adverse remodeling, serving as a marker for a high-risk phenotype.
Absolute Event Rate: 0% vs 0%
Abstract Background In patients with hypertrophic cardiomyopathy (HCM), left ventricular (LV) reverse septal curvature (RSC) is more commonly observed in individuals with sarcomeric mutations. In addition, RSC has been associated, higher levels of late gadolinium enhancement (LGE) and an increased prevalence of major ventricular arrhythmias. However, the anatomical and functional characteristics of patients with RSC remain poorly understood. Purpose This study aims to systematically characterize the clinical and imaging features of patients with HCM, comparing those with and without RSC. Methods The study population consisted of 99 consecutively enrolled patients with HCM with at least 15 mm of maximal wall thickness (MWT) (23% women, mean age 58±15 years). All participants underwent a comprehensive clinical evaluation and echocardiographic assessment, including 2D and full volume 3D imaging with measurement of global and regional ejection fraction (EF), global longitudinal strain (GLS), and Doppler echocardiography. 71 patients performed also Nuclear Magnetic Resonance, with evaluation of LGE, whereas 68 patients were genetically screened. Reverse septal curvature (RSC) was defined as a LV septum that curved convexly toward the LV cavity. To test the association between regional EF (basal, mid and apical) and the presence of reverse curvature, a linear mixed-effect regression model was employed with interaction and with patient ID as random effect. Results 46 patients showed RSC, whereas the remaining 54 did not (noRSC). Differences between groups are reported in the Table. Only patients with RSC showed LV aneurysm (n=11). The interaction between LV EF at apical level and the reverse curvature was significant (b=-16, p0.001), indicating that the presence of reverse curvature negatively influences the difference between apical and basal EF measurements. By excluding patients with LV aneurysm: 1) the interaction coefficient did not reach statistical significance (b=-4, p=0.074), however suggesting that the negative effect of reverse curvature on apical measurements reduces but still persists in absence of aneurysm (Figure); 2) overall differences between NoRSC and RSC groups hold significant (Figure).. Conclusion Our study found that RSC is associated with LV aneurysm and intraventricular gradient. By excluding patients with LV aneurysm, the clinical and the haemodynamic profile did not change, suggesting that RSC is per se a marker of high-risk phenotype and adverse remodelling.
Polizzi et al. (Sat,) reported a other. Reverse septal curvature in HCM patients is associated with LV aneurysm, intraventricular gradient, and adverse remodeling, marking a high-risk phenotype.