Lowering the Recommended Maximal Wall Thickness Threshold Improves Diagnostic Sensitivity in Asians With Hypertrophic Cardiomyopathy

Figures

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  Figure 1. Assessment of Myocardial Wall Thickness and Morphology Myocardial wall thickness was measured using a semiautomated approach (CVI42). (A) Wall thickness was estimated using 50 chords per myocardial slice in the short-axis view, according to the 16-segment model. (B) The distribution of hypertrophy in hypertrophic cardiomyopathy was classified based on the following: reversed curvature, neutral, sigmoid septum; apical and nonseptal hypertrophy. AHA = American Heart Association.

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  Figure 2. WTMax in Patients With HCM Compared to healthy volunteers, patients with hypertrophic cardiomyopathy (HCM) had increased maximal wall thickness (WTMax) either in absolute values (A) or indexed to body surface area (B). (A, B) WTMax demonstrated excellent ability to discriminate HCM from healthy volunteers. The recommended threshold of 15.0 mm in contemporary guidelines had excellent specificity of 100% but low sensitivity of 51% in diagnosing HCM in Asians. Lowering the absolute WTMax to 12.0 mm in male and 10.0 mm in female populations will improve sensitivity (84%) without changing specificity (100%). To account for differences in body sizes, an indexed WTMax of 6.5 mm/m2 and 4.5 mm/m2 are associated with 100% specificity and sensitivity, respectively (same threshold in either sex). Box-plot shows mean ± SD. AUC = area under the curve.

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  Central Illustration. Sex-Specific Maximal Wall Thickness Thresholds in Asians With Hypertrophic Cardiomyopathy Sex-specific (or indexed for both sexes) maximal wall thickness thresholds established in the study demonstrate high diagnostic sensitivity and specificity in Asians with hypertrophic cardiomyopathy.