Key result
Thickness-adjusted strain detects ~3-point lower regional deformation than standard strain in severe HCM.
Why the study?
Conventional strain software uses a uniform region-of-interest width across the entire wall, only partially analyzing hypertrophic left ventricular segments in hypertrophic cardiomyopathy.
Does longitudinal strain adjusted to regional thickness improve the evaluation of myocardial deformation in hypertrophic cardiomyopathy compared to standard strain?
Cross-Sectional (n=110)
No
Does longitudinal strain adjusted to regional thickness improve the evaluation of myocardial deformation in hypertrophic cardiomyopathy compared to standard strain?
Answers are grounded in this paper and cite their sources.
Adjusting echocardiographic longitudinal strain measurement to regional myocardial thickness improves tracking feasibility and unmasks more profound deformation impairment in severely hypertrophied segments of patients with HCM.
Background. We assessed the usefulness of a longitudinal strain adjusted to regional thickness in hypertrophic cardiomyopathy (HCM). Indeed, with conventional software, the width of the region of interest (ROI) is the same over the entire myocardial wall, wherein the software analyzes only partially the left ventricular (LV) hypertrophic segments. Methods. We included 110 patients: 55 patients with HCM (HCM group) and 55 healthy subjects (age- and sex-matched control group). The global longitudinal strain (GLS) and regional strain for each of the 17 segments was calculated with standard software (for two groups) and with software adjusted to the myocardial wall thickness (for the HCM group). Results. GLS was significantly decreased in the HCM group compared to the control group (−15.1 ± 4.8% versus −20.5 ± 4.3%, p < 0.0001). In the HCM group, GLS (standard method versus adjusted to thickness) measurements were not significantly different (p = 0.34). Interestingly, the regional strain adjusted to thickness was significantly lower than the standard strain in the hypertrophic segments, especially in the basal inferoseptal segment (p = 0.0002), median inferoseptal segment (p < 0.001) and median anteroseptal segment (p = 0.02). The strain adjusted to thickness was still significantly lower in the most hypertrophic segments (≥20 mm) (−3.7 ± 3%, versus −5.9 ± 4.4%, p = 0.049 in the basal inferoseptal segment and −5.7 ± 3.5% versus −8.3 ± 4.5%, p = 0.0007 in the median inferoseptal segment). In the segments with significant myocardial fibrosis, the longitudinal strain adjusted to thickness was significantly lower than the conventional strain (−8.3 ± 3.3% versus −11.4 ± 4.5%, p = 0.002). The analysis of the strain adjusted to thickness had a better feasibility (97.5% versus 99%, p = 0.01). Conclusions. The analysis of a longitudinal strain adjusted to regional thickness is feasible in HCM and allows a better evaluation of myocardial deformation, especially in the most LV hypertrophic segments.
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Urtado et al. (2022) conducted a cross-sectional in Hypertrophic cardiomyopathy (n=110). Echocardiographic longitudinal strain analysis adjusted to regional thickness vs. Standard echocardiographic longitudinal strain analysis was evaluated on Regional longitudinal strain in the median inferoseptal segment (hypertrophic segments ≥20 mm) (p=0.0007). Longitudinal strain adjusted to regional thickness demonstrated significantly lower regional strain in severely hypertrophic segments compared to standard strain (-5.7% vs -8.3%, p=0.0007), allowing for a better evaluation of myocardial deformation in hypertrophic cardiomyopathy.
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