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Myocardial deformation analysis using cardiac magnetic resonance in apical hypertrophic cardiomyopathy
Session:
Comunicações Orais (Sessão 23) - Doenças do Miocárdio e Pericárdio 1 - Miocardiopatia hipertrófica
Speaker:
Raquel Menezes Fernandes
Congress:
CPC 2022
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.2 Myocardial Disease – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Raquel Menezes Fernandes; Ricardo Ladeiras Lopes; Rita Faria; Nuno Dias Ferreira; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> Apical hypertrophic cardiomyopathy (aHCM) has a broad phenotypic spectrum and still poses many diagnostic and prognostic challenges. Myocardial deformation analysis using cardiac magnetic resonance tissue tracking (CMR-TT) has shown value as an adverse events predictor in classic HCM, but information in aHCM is scarce.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose: </strong>To examine the prognostic value of myocardial deformation obtained with CMR-TT analysis in predicting adverse outcomes in aHCM patients.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>We conducted a retrospective study enrolling patients referred to CMR in our Cardiology Department from August 2009 to October 2021, to whom the diagnosis of aHCM was made. CMR-TT analysis was performed to each patient to characterize the myocardial deformation pattern. We further analysed clinical and other complementary diagnostic exams characteristics, as well as follow-up data. Primary endpoint was the composite of all-cause hospitalizations and mortality.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> During the 12-year period, 51 patients with aHCM were diagnosed by CMR, with a median age of 64 years-old and male predominance (60,8%). Family history of HCM or sudden cardiac death was present in 7,8%. T-wave inversion on resting electrocardiogram was present in 78,4% of patients and 56,9% had an echocardiogram suggestive of aHCM. Patients expressed the "relative form" in 43,1%, 37,3% had the “pure apical” form and 17,6% the "mixed form". In our population, median maximum left ventricle (LV) thickness was 15 mm, with a median LV mass index of 76 g/m<sup>2</sup>. Late gadolinium enhancement was present in 78,4% of patients, in a median of five LV segments. Applying CMR-TT analysis, median global longitudinal strain was -14,4%, with a median global radial strain of 30,4% and global circumferential strain of -18,0%. During a median follow-up of 5,3 years, no patient had sustained ventricular dysrhythmias, but 21,6% had non-sustained ventricular tachycardia on 24h-Holter. Primary endpoint occurred in 10 patients (21,3%), with a hospitalization rate of 17,8% (cardiac causes in 2%) and all-cause mortality rate of 6,4%. Those patients were older (69,2 vs 59,5 years-old; p=0,01), had a larger prevalence of chronic obstructive pulmonary disease (20% vs 2,7%; p=0,047), and lower longitudinal strain rate in apical segments (0,27 vs -0,74 s<sup>-1</sup>; p=0,021). After multivariable analysis, only longitudinal strain rate in apical segments was an independent predictor of the primary endpoint (p=0,023).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong>CMR-TT analysis, namely through longitudinal strain rate, could be useful in predicting adverse outcomes in aHCM.</span></span></p>
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