4920Prognostic implication of relative apical sparing pattern in non-ischemic patients with diffuse left ventricular hypertrophy

Background: Relative apical sparing pattern of left ventricular longitudinal strain [RapSP-LS; Figure (left)] is determined on the strain polar map at the time of measurement of global longitudinal strain (GLS) during speckle tracking echocardiography. This pattern is frequently observed in patients with cardiac amyloidosis. Some patients with infiltrative cardiomyopathy and severe hypertensive heart disease may also exhibit this pattern. These diseases are characterized by diffuse left ventricular hypertrophy (LVH) and are associated with poor outcomes. Purpose: We sought to investigate the association of RapSP-LS with major adverse cardiovascular events (MACE) in patients with diffuse LVH, independent of and incremental to clinical and echocardiographic parameters. Methods: We retrospectively studied 399 consecutive non-ischemic patients with diffuse LVH (LV mass index >115 g/m2 for males and >95 g/m2 for females) and preserved ejection fraction (>50%) between 2008 and 2014. Patients with asymmetric septal hypertrophy, severe valvular heart disease, or severe heart failure (NYHA 3 or 4) were excluded. RapSP-LS was visually determined by two blinded sonographers with reference to previous papers; any disagreement was resolved by a third person. Relative apical longitudinal strain index (RapLSI) [average apical LS/(average basal LS + average mid-ventricle LS)] and GLS were also measured. Patients were followed-up for MACE (cardiac death, unexpected admission due to heart failure or acute myocardial infarction) over a median duration of 4.8 years. A Cox proportional hazards model was used to assess the association of parameters with MACE.