Key result
GFI-M improves detection of LV systolic dysfunction over GFI-I with a ~0.11 higher AUC.
Why the study?
Does a geometric functional index based on maximal myocardial thickness improve the detection of left ventricular systolic impairment compared to an index based on the interventricular septum in patients with hypertrophic cardiomyopathy?
Cross-Sectional (n=55)
No
Does a geometric functional index based on maximal myocardial thickness improve the detection of left ventricular systolic impairment compared to an index based on the interventricular septum in patients with hypertrophic cardiomyopathy?
Effect estimate: ΔAUC 0.112 (95% CI 0.018-0.207)
Absolute Event Rate: 0.959% vs 0.847%
p-value: p=0.020
A simple cardiac MRI geometric functional index mapping LVEDD against maximal hypertrophic wall thickness accurately detects subtle left ventricular systolic impairment in HCM patients.
GFI-M may aid detection of subtle LV systolic impairment in HCM on MRI; hypothesis-generating and requires prospective validation before clinical adoption.
BACKGROUND The effects of focal hypertrophy on geometry of the left ventricle and systolic function have not been studied in patients with hypertrophic cardiomyopathy (HCM), despite the fact that the former is the most prominent disease characteristic. The aim of our study was to analyze systolic function over ventricle geometry, generating a functional index made from left ventricle end diastolic dimension (LVEDD) divided by end diastolic thickness of the region with maximal extent of hypertrophy and interventricular septum. MATERIAL AND METHODS Our hospital database of cardiac magnetic resonance was screened for HCM. Geometric functional index (GFI) was calculated for LVEDD over maximal end diastolic thickness (MaxEDT) giving GFI-M, while LVEDD over interventricular septum was expressed as GFI-I. There were 55 consecutive patients with HCM. RESULTS There were 43 males (78.2%) and 12 females (21.8%). The mean age was 52.3±16.7 years (range: 15.5-76.4 years). A significant difference of GFI was found for preserved versus impaired systolic function of the left ventricle (preserved systolic function); GFI-M 2.28±0.60 versus 3.66±0.50 (p<0.001), and GFI-I 2.75±0.88 versus 3.81±0.87 (p<0.001), respectively. Diagnostic value was tested using receiver operating curve (ROC) analyzes, with GFI-M area under curve (AUC)=0.959 (95% CI: 0.868-0.994); (p<0.001) and GFI-I-AUC=0.847 (0.724-0.930); (p<0.001). GFI-M was superior to GFI-I for appraisal of left ventricle systolic dysfunction in HCM; ΔAUC=0.112 (0.018-0.207); (p=0.020). CONCLUSIONS GFI is a simple tool, with high sensitivity and specificity for detecting impairment of systolic function in patients with HCM. Further studies would be necessary to investigate its clinical and prognostic impacts, as well as reproducibility with prospective validation.
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Boban et al. (2018) conducted a cross-sectional in Hypertrophic cardiomyopathy (n=55). Geometric functional index of maximal hypertrophy (GFI-M) vs. Geometric functional index of interventricular septum (GFI-I) was evaluated on Detection of left ventricle systolic dysfunction (LVEF <50%) using ROC AUC (ΔAUC 0.112, 95% CI 0.018-0.207, p=0.020). The geometric functional index based on maximal myocardial thickness (GFI-M) significantly improved the detection of left ventricular systolic dysfunction compared to the index based on the interventricular septum (ΔAUC 0.112, p=0.020).
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