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Three dimensional myocardial deformation parameters are associated with functional capacity in hypertrophic cardiomyopathy
Session:
Comunicações Orais (Sessão 23) - Doenças do Miocárdio e Pericárdio 1 - Miocardiopatia hipertrófica
Speaker:
Pedro Brás
Congress:
CPC 2022
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.3 Myocardial Disease – Diagnostic Methods
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Pedro Garcia Brás; Isabel Cardoso; Sílvia Aguiar Rosa; Luísa Moura Branco; Ana Galrinho; António Valentim Gonçalves; André Grazina; José Viegas; Mafalda Selas; Filipa Silva; Rui Cruz Ferreira
Abstract
<p><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif">Introduction: Three-dimensional (3D) echocardiography is an emerging tool for assessment of left ventricular function, with a promising role in the evaluation of cardiomyopathies. Hypertrophic cardiomyopathy (HCM) is often associated with reduced exercise capacity. The aim of this study was to evaluate the importance of 3D myocardial deformation as a predictor of exercise capacity in HCM patients (P).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif">Methods: This prospective study enrolled P with HCM. Each P underwent a comprehensive transthoracic echocardiogram including 3D speckle-tracking to measure global longitudinal, radial and circumferential strain, twist, torsion and global area strain. Functional capacity was objectively assessed by treadmill cardiorespiratory exercise testing.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif">Results: 83 P with HCM, 50 (60%) male, mean LV ejection fraction (LVEF) of 68±7%, 27 (33%) with obstructive HCM (LV outflow tract [LVOT] gradient of 89±60 mmHg). Impairment in LV myocardial deformation parameters was significantly correlated with lower peak VO2: global longitudinal 3D strain (r=-0.397, p<0.001), global radial 3D strain (r=0.336, p=0.003) and global circumferential 3D strain (r=-0.353, p=0.002).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif">Impaired LV twist was significantly correlated with inferior peak VO2 (r=0.264, p=0.033) (Figure 1) and peak circulatory power (r=0.371, p=0.003). Torsion impairment also significantly associated with lower peak VO2 (r=0.285, p=0.021), circulatory power (r=0.380, p=0.002), time to ventilatory anaerobic threshold (VAT) (r=0.369, p=0.003) and (VE/VCO2 slope)/peak VO2 ratio (r=-0.316, p=0.012).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif">Furthermore, global area strain impairment showed significant relation with decreased peak VO2 (r=-0.368, p=0.001), lower exercise duration (r=-0.384, p=0.001), time to VAT (r=-0.404, p<0.001), circulatory power (r=-0.272, p=0.032) and (VE/VCO2 slope)/peak VO2 ratio (r=0.391, p=0.002). LV twist (r=-0.135, p=0.284), torsion (r=-0.120, p=0.341) and global area strain (r=0.152, p=0.235) impairment did not correlate with VE/VCO2 slope. Exercise capacity was not associated with LV mass index (r=0.209, p=0.095), maximum wall thickness (r=0.041, p=0.744), LVEF (r=-0.092, p=0.458), 2D global longitudinal strain (r=-0.024, p=0.848) or peak LVOT gradient (r=-0.006, p=0.964).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif">In a subanalysis examining only the nonobstructive (nHCM) P, we found that peak VO2 had a superior correlation with global longitudinal 3D strain (r=-0.420, p=0.004), global radial 3D strain (r=0.356, p=0.016) and global circumferential 3D strain (r=-0.357, p=0.016) as well as LV twist (r=0.300, p=0.046) and torsion (r=0.336, p=0.024).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif">Conclusion: Although P with HCM often have supranormal LVEF, 3D speckle-tracking echocardiographic imaging has the potential to demonstrate subclinical impairment of LV function. Impaired LV 3D strain, twist, torsion and global area strain were associated with reduced exercise capacity, particularly in nHCM P.</span></span></p>
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