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Myocardial work: a new way to predict fibrosis in hypertrophic cardiomyopathy patients
Session:
Painel 3 - Imagiologia Cardiovascular 4
Speaker:
António Valentim Gonçalves
Congress:
CPC 2020
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.6 Cross-Modality and Multi-Modality Imaging Topics
Session Type:
Posters
FP Number:
---
Authors:
António Valentim Gonçalves; Sílvia Aguiar Rosa; Luisa Moura Branco; Ana Galrinho; António Fiarresga; Luís Lopes; Boban Thomas; Luís Baquero; Miguel Mota Carmo; Rui Cruz Ferreira
Abstract
<p><strong>Introduction</strong></p> <p>Late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) adds important prognostic information for hypertrophic cardiomyopathy (HCM) patients. Myocardial work (MW), a new transthoracic echocardiographic (TTE) parameter, is able to assess myocardial performance through left ventricular (LV) global longitudinal strain information. Whether MW can predict LGE on CMR is unknown.</p> <p> </p> <p><strong>Aim</strong></p> <p>Evaluate if MW can predict the presence of significant LV fibrosis in HCM patients.</p> <p> </p> <p><strong>Methods </strong></p> <p>Prospective evaluation of HCM patients in which several exams were performed baseline, including a TTE and a CMR.</p> <p>MW and related indices (global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE) and global work index (GWI)) were calculated from global longitudinal strain and from estimated LV pressure using the GE Vivid E95 ultrasound system.</p> <p>CMR was performed on a 3-T system. The regional LGE extent was quantitatively assessed on a per-segment basis. LGE ≥ 20% was chosen to define significant fibrosis.</p> <p>Univariable logistic regression analysis was performed to find the variables associated with LGE ≥ 20%. In these variables, cut-off values were determined by the area under the curve (AUC) analysis so that the sum of sensitivity and specificity was maximized. Statistical differences with a p value <0.05 were considered significant.</p> <p> </p> <p><strong>Results</strong></p> <p>There were 32 patients enrolled in this analysis. Mean age was 57 ± 16 years, with 18 (56%) male patients with a mean LV ejection fraction by TTE of 67 ± 8%.</p> <p>In the per-segment analysis, GWI (1242 ± 720mmHg% vs 1556 ± 734mmHg%, p<0.001) and GWE (88 ± 15% vs 92 ± 13%, p=0.012) had significantly lower values in the segments with fibrosis.</p> <p>Table 1 shows the univariable logistic regression analysis results. GCW was the only significant predictor. A cut-off of ≤ 1550 mmHg% was able to predict LV myocardial fibrosis ≥ 20% with a sensitivity of 87% and a specificity of 82%, while the best cut-off for GLS (> -15) had the same specificity but a lower sensitivity of 73%.</p> <p> </p> <p><strong>Conclusion</strong></p> <p>GCW was the best parameter to predict significant LV myocardial fibrosis in CMR. Further studies should evaluate his utility in patients who cannot perform CMR.</p>
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