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Association between microcirculatory dysfunction and impaired myocardial deformation in hypertrophic cardiomyopathy
Session:
Sessão de Comunicações Orais - Doenças do Miocárdio
Speaker:
Silvia Aguiar
Congress:
CPC 2020
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:
Sílvia Aguiar Rosa; Luisa Moura Branco; Boban Thomas; António Fiarresga; Luís Lopes; Ana Galrinho; Mafalda Selas; Filipa Silva; Ricardo Pereira; Gonçalo Branco; Catarina Barão; Luís Baquero; Miguel Mota Carmo; Rui Cruz Ferreira
Abstract
<p><strong>Background: </strong>Microcirculatory dysfunction may impair left ventricular (LV) performance in hypertrophic cardiomyopathy (HCM).</p> <p> </p> <p><strong>Objective</strong>: To analyze the relationship between coronary microcirculatory dysfunction and LV myocardial deformation in HCM.</p> <p> </p> <p><strong>Methods: </strong>The present study prospectively included HCM adult patients (P). Microcirculatory dysfunction was assessed by stress cardiovascular magnetic resonance (CMR), during regadenoson-induced hyperemia. For perfusion assessment, the myocardium was divided into 32 subsegments (16 AHA segments subdivided into an endocardial and epicardial layer, excluding segment 17). Ischemic burden was calculated as the number of involved subsegments, assigning 3% of myocardium to each subsegment. Epicardial coronary artery disease was excluded by computed tomography or invasive coronary angiography.</p> <p>LV myocardial deformation was evaluated by two (2D) and three-dimensional (3D) speckle-tracking echocardiography (STE), including global longitudinal strain (GLS), peak systolic dispersion (PDS), global circumferential strain (GCS), global radial strain (GRS), area strain, twist and torsion.</p> <p> </p> <p><strong>Results: </strong>31 P were enrolled (51% male, mean age 57.8±15.5 years). Asymmetric septal hypertrophy was seen in 55%, apical in 29%, concentric in 16%, with maximal wall thickness (MWT) of 20.5±4.9mm; 26% with evidence of LVOT obstruction; LV ejection fraction 67.9±7.9%.</p> <p>In 2DSTE analysis, P with more ischemia (> 20% of LV) presented more severe impaired GLS and greater PDS, comparing with patients with ≤20% of ischemia (table 1).</p> <p>Similarly, 3DSTE imaging showed worse LV performance in P with greater ischemic burden, expressed by significant difference in GLS, GRS and area strain. GCS also trended to be worse in the presence of >20% of ischemia. No statistically significant difference was achieved between groups regarding twist and torsion. (table 1)</p> <p>The stronger correlation was found between 2D GLS and ischemic burden (Pearson correlation factor 0.545; p=0.002).</p> <p> </p> <p><strong>Conclusion: </strong>In HCM, the severity of ischemia secondary to microcirculation dysfunction was associated with impairment in LV myocardial deformation evaluated by 2D and 3D STE.</p>
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