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Microvascular dysfunction is associated with impaired myocardial work in obstructive and nonobstructive hypertrophic cardiomyopathy: a multimodality approach
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; Boban Thomas; Miguel Mota Carmo; António Fiarresga; Gonçalo Branco; Ricardo Pereira; Mafalda Selas; Filipa Silva; Luís Rocha Lopes; Rui Cruz Ferreira
Abstract
<p><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif">Introduction: Myocardial work is a dynamic non-invasive method for assessing myocardial deformation. Microvascular dysfunction is a hallmark of hypertrophic cardiomyopathy (HCM). We hypothesized that there is an association between impaired myocardial work, evaluated by echocardiography, and left ventricular (LV) ischemia, detected by cardiac magnetic resonance (CMR).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif">Methods: Prospective assessment of HCM patients’ (P) myocardial strain parameters with 2D speckle-tracking echocardiography. All P underwent CMR protocol (1.5-T) for the analysis of stress perfusion and late gadolinium enhancement (LGE). Perfusion defects were quantified as burden of ischemia (% of LV mass). Results were stratified according to obstructive (oHCM) and nonobstructive (nHCM) HCM as well as according to the presence of significant replacement fibrosis (LGE of ≥15% or <15% of LV mass). Multivariate regression analyses were used to explore the relation between myocardial work and the burden of ischemia.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif">Results: 75 P with HCM (63% male, age 55±15 years), 61% with asymmetric septal LVH, 29% with apical LVH, 8% with concentric LVH and 28% exhibiting LV outflow tract obstruction (mean maximal LVOT gradient of 89±60 mmHg). Perfusion defects were found in 68 P (90.7%), with a mean of 22.5±16.9% of LV mass and 29 P (38.7%) had LGE ≥15% of LV mass.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif">A lower global work index (GWI) significantly correlated with higher burden of myocardial perfusion defects (r=-0.520, β-estimate -0.019, 95% CI -0.028 to -0.010, p<0.001). Likewise, impaired values of global work efficiency (GWE) were linked to higher percentage of hypoperfusion (r=-0.477, β-estimate -0.713, 95% CI -1.250 to -0.176, p<0.001). Moreover, impaired global constructive work (GCW) (r=-0.519, β-estimate -0.021, 95% CI -0.030 to -0.013, p<0.001) and a higher global wasted work (GWW) (r=0.280, p=0.017) were associated with a higher burden of perfusion defects.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif">GWI showed a higher correlation with perfusion defects in oHCM P (r= -0.492, p<0.001) vs. nHCM P (r=-0.158, p=0.019), and the same was also found with GWE (oHCM: r=-0.591, p=0.006 vs. nHCM: r=-0.317, p=0.022). Furthermore, GCW showed a slightly higher correlation with hypoperfusion in oHCM P (r= -0.564, p=0.010) vs. nHCM P (r=-0.520, p<0.001). There was no significant difference between oHCM and nHCM P regarding GWW.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif">In P with LGE ≥15%, GWI showed a better correlation with perfusion defects (r=-0.489, p=0.007) vs. P with LGE of <15% (r=-0.369, p=0.007). Moreover, GCW showed a higher correlation with hypoperfusion in P with LGE ≥15% (r=-0.455, p=0.013) comparing with P with LGE <15% LV mass (r=-0.359, p=0.019). No difference was found regarding GWE and GWW according to LGE burden.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif">Conclusion: In our cohort of P with HCM, impaired GWI, GWE and GCW and a higher GWW were significantly correlated with the presence of myocardial ischemia in CMR. This correlation was greater in P with oHCM and in P with LGE of ≥15% of LV mass.</span></span></p>
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