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Makoto Saito, Hideki Okayama, Toyofumi Yoshii, Haruhiko Higashi, Hiroe Morioka, Go Hiasa, Takumi Sumimoto, Shinji Inaba, Kazuhisa Nishimura, Katsuji Inoue, Akiyoshi Ogimoto, Yuji Shigematsu, Mareomi Hamada, Jitsuo Higaki, Clinical significance of global two-dimensional strain as a surrogate parameter of myocardial fibrosis and cardiac events in patients with hypertrophic cardiomyopathy, European Heart Journal - Cardiovascular Imaging, Volume 13, Issue 7, July 2012, Pages 617–623, https://doi.org/10.1093/ejechocard/jer318
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Abstract
Late gadolinium enhancement (LGE) on contrast-enhanced magnetic resonance imaging (MRI) in hypertrophic cardiomyopathy (HCM) has been reported to be associated with myocardial fibrosis and cardiac events. In patients with HCM, two-dimensional (2D) strain can identify subclinical global systolic dysfunction despite normal left ventricular (LV) chamber function. Therefore, this study tested the hypothesis that global 2D strain could detect subtle myocardial fibrosis and serve as a novel prognostic parameter in HCM patients.
Echocardiography and MRI were performed in 48 consecutive patients with HCM and normal chamber function. We measured global longitudinal strain (GLS) in apical two-chamber, four-chamber, and long-axis views using speckle-tracking analysis. The extent of LGE (%LGE = LGE volume/total LV volume) and LV mass index were calculated by MRI using Simpson's rule and custom software. All patients were followed up for major cardiac events. Global longitudinal strain in patients with LGE was significantly lower than that without LGE (−11.8 ± 2.8 vs. −15.0 ± 1.7%, P < 0.001). Multivariate analysis showed that GLS was an independent predictor of %LGE (standard coefficient = 0.627, P < 0.001). During a mean follow-up period of 42 ± 12 months, five patients had cardiac events. When the patients were stratified based on the median level of GLS (−12.9%), all events were observed in the worse GLS group (P = 0.018).
These results suggest that global 2D strain might provide useful information on myocardial fibrosis and cardiac events in HCM patients with normal chamber function.
- hypertrophic cardiomyopathy
- magnetic resonance imaging
- echocardiography
- myocardial fibrosis
- left ventricle
- cardiac event
- follow-up
- gadolinium
- software
- systole
- patient prognosis
- systolic dysfunction
- apical four chamber view
- total liquid ventilation
- simpson's rule method
- two-dimensional speckle tracking
- longitudinal strain
- contrast-enhanced magnetic resonance imaging
- long axis