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Impact of left ventricular outflow tract obstruction on left ventricular mechanics in patients with hypertrophic cardiomyopathy
Session:
CO 13 - Miocárdio e Pericárdio
Speaker:
Mário Rui Lourenço
Congress:
CPC 2018
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.1 Myocardial Disease – Pathophysiology and Mechanisms
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Mário Lourenço; Olga Azevedo; Filipa Castro; Bebiana Faria; Margarida Oliveira; Marina Pereira Fernandes; Isabel Nogueira; António Lourenço
Abstract
<p>Purpose:<br /> Evaluation of left ventricular (LV) myocardial deformation obtained by speckle tracking in patients with asymmetric<br /> hypertrophic cardiomyopathy (HCM). Evaluation of the impact of LV outflow tract obstruction in LV twist and torsion in<br /> patients with HCM.</p> <p><br /> Methods:<br /> Prospective study including 54 patients with asymmetric HCM, 17 of them with LV outflow tract obstruction at<br /> rest. Transthoracic echocardiogram was performed with evaluation of LV strain by 2D speckle tracking, including LV<br /> twist and torsion.</p> <p><br /> Results:<br /> No statistically significant differences were found in global longitudinal strain (p=0,7) and strain rate (p=0,89) neither in<br /> global radial strain (p=0,49) and strain rate (p=0,56) or global circumferential strain (p=0,07) however there was a<br /> statistically significant difference in global circumferential strain rate (GCSR) between these two groups (p=0,019)<br /> LV twist and torsion were increased in patients with obstructive HCM, when compared to patients with non-obstructive<br /> HCM (30.22±7,95 vs. 23,16±7,95 p=0,003 and 3,59±0,95 vs. 2,97±1,04 p=0,05, respectively), in whom LV twist and<br /> torsion were preserved. The increase of LV twist and torsion in patients with obstructive HCM was due to an increase<br /> of LV apical rotation (p=0,015). Multivariate regression analysis identified the pressure gradient on the LV outflow tract<br /> as an independent predictor of LV twist in patients with HCM (p<0,001). It also identified the pressure gradient on the<br /> LV outflow tract and left ventricular mass (LVM) as independent predictors of LV torsion in these patients (p=0,003 and<br /> p=0,038, respectively).</p> <p><br /> Conclusion:<br /> LV twist is increased in patients with obstructive HCM due to an increase of LV apical rotation. GCSR is statistically<br /> different between patients with obstructive and non-obstructive forms of HCM. The pressure gradient in the LV outflow<br /> tract is an independent predictor of LV twist and torsion in patients with asymmetric HCM. LVM is an independent<br /> predictor of LV torsion in these patients.</p>
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