What is the clinical evidence from this study?

Study design: Observational. Population: Hypertrophic cardiomyopathy (n=80). Intervention: Hypertrophic cardiomyopathy vs. Healthy volunteers. Primary outcome: Left ventricular global longitudinal strain (GLS) (p=<0.001).

December 17, 2013

Left Ventricular and Atrial Functions in Hypertrophic Cardiomyopathy Patients with Very High LVOT Gradient: A Speckle Tracking Echocardiographic Study

Q: What are the key findings of this study?

Hypertrophic cardiomyopathy was associated with significantly impaired left ventricular global longitudinal strain compared to healthy controls (-20.3% vs. -24.1%, P<0.001).

Key Result

Hypertrophic cardiomyopathy was associated with significantly impaired left ventricular global longitudinal strain compared to healthy controls (-20.3% vs. -24.1%, P<0.001).

Study Design

Type

Observational (n=80)

PICO

Population

80 participants, comprising 40 patients with hypertrophic cardiomyopathy and 40 healthy volunteers, evaluated for left ventricular and atrial functions using 2D speckle tracking echocardiography.

Exposure / Comparator

Hypertrophic cardiomyopathy vs Healthy volunteers

Primary Outcome

Left ventricular global longitudinal strain (GLS), p=<0.001

Main Result

Absolute Event Rate: -20.3% vs -24.1%

p-value: p=<0.001

Limitations

Preliminary results requiring further studies to clarify the findings

Abstract

BACKGROUND: Determination of myocardial deformation (strain) by two-dimensional (2D) speckle tracking echocardiography (STE) is a new method for evaluating left ventricular (LV) regional function in patients with hypertrophic cardiomyopathy (HCM). The aim of this study was to assess LV and left atrial (LA) functions with 2DSTE in HCM patients and to investigate relation between strain analysis and LV outflow tract (LVOT) gradient. METHODS: Forty consecutive HCM patients (26 male, mean age: 47.7 ± 15.2 years), and 40 healthy volunteers (22 male, mean age: 46.6 ± 11.2 years) were included in the study. All subjects underwent a transthoracic echocardiography for evaluation of LV and LA functions with 2DSTE. The HCM patients were divided into 2 groups according to the presence of resting LVOT gradient >100 mmHg. RESULTS: Left ventricular global longitudinal strain (GLS), global radial strain (GRS), and global circumferential strain (GCS) were significantly lower in patients with HCM compared with controls (-20.3 ± 3.6% vs. -24.1 ± 3.4% P 100 mmHg and they had significantly decreased GLS, twist and untwist compared to the HCM patients with lower resting LVOT gradient (-18.7 ± 2.3% vs. -21.2 ± 3.9% P = 0.016, 19.4 ± 4.3° vs. 23.5 ± 7.4° P = 0.038 and -94.0 ± 29.1°/sec vs. -134.9 ± 55.8°/sec, 0.005, respectively). Although basal and apical rotation were similar between the 2 groups, mid-rotation was significantly clockwise in HCM patients with higher LVOT gradient (-2.52 ± 1.76° vs. -0.96 ± 2.03°, P = 0.018). Correlation analysis revealed that LVOT peak velocity was associated with GLS (r = -0.358, P = 0.023), LV mid-rotation (r = -0.366, P = 0.024), and LV untwist (r = -0.401, P = 0.013). CONCLUSIONS: Left ventricular and LA functions are impaired in patients with HCM. 2DSTE is useful in determining patients with impaired myocardial mechanics. High LVOT gradient may be one of the responsible factors that trigger deterioration of LV longitudinal strain and twist mechanics in patients with HCM. Further studies are required to clarify the preliminary results of this study.

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