Abstract
Late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) adds prognostic information in patients with hypertrophic cardiomyopathy (HCM). Whether Myocardial work (MW), a new parameter on transthoracic echocardiographic (TTE), can predict significant fibrosis in HCM patients is unknown.
Single-centre evaluation of consecutively recruited HCM patients in which TTE and CMR were performed. MW and related indices were calculated from global longitudinal strain (GLS) and from estimated left ventricular pressure curves. The extent of LGE was quantitatively assessed. LGE ≥15% was chosen to define significant fibrosis.
Logistic regression analysis was used to find the variables associated with LGE ≥15% and cut-off values were determined.
Among the thirty-two patients analysed mean age was 57±16 years, 18 (56%) were male patients and the mean left ventricular ejection fraction by TTE was 67±8%.
Global constructive work (GCW), global work index and GLS were significant predictors of LGE ≥15%. A cut-off ≤1550 mmHg% of GCW was able to predict significant fibrosis with a sensitivity of 92% and a specificity of 79%, while the best cut-off for GLS (>−15%) had a sensitivity of 86% and a specificity of 72%.
GCW was the best parameter to predict significant left ventricular myocardial fibrosis in CMR, suggesting its utility in patients who may not be able to have a CMR study.
Predictors of LV fibrosis using LGE ≥15% (6sd)
| Parameter | p | HR | 95% CI |
|---|---|---|---|
| Age | 0.147 | 0.976 | 0.944–1.009 |
| QTc interval | 0.727 | 1.005 | 0.976–1.035 |
| HCM risk score | 0.180 | 1.177 | 0.927–1.495 |
| LV end-diastolic diameter (TTE) | 0.438 | 1.046 | 0.934–1.172 |
| LV mass index (TTE) | 0.638 | 1.002 | 0.994–1.010 |
| LV ejection fraction (TTE) | 0.508 | 0.976 | 0.909–1.048 |
| Global Longitudinal Strain (TTE) | 0.032 | 0.886 | 0.792–0.990 |
| RV-RA gradient (TTE) | 0.224 | 1.035 | 0.979–1.094 |
| LV mass index (CMR) | 0.121 | 1.010 | 0.997–1.023 |
| T1 mapping (CMR) | 0.133 | 1.011 | 0.997–1.026 |
| GWI | 0.020 | 0.999 | 0.997–1.000 |
| GWE | 0.186 | 0.961 | 0.907–1.019 |
| GWW | 0.469 | 1.002 | 0.997–1.007 |
| GCW | 0.019 | 0.999 | 0.997–1.000 |
| Parameter | p | HR | 95% CI |
|---|---|---|---|
| Age | 0.147 | 0.976 | 0.944–1.009 |
| QTc interval | 0.727 | 1.005 | 0.976–1.035 |
| HCM risk score | 0.180 | 1.177 | 0.927–1.495 |
| LV end-diastolic diameter (TTE) | 0.438 | 1.046 | 0.934–1.172 |
| LV mass index (TTE) | 0.638 | 1.002 | 0.994–1.010 |
| LV ejection fraction (TTE) | 0.508 | 0.976 | 0.909–1.048 |
| Global Longitudinal Strain (TTE) | 0.032 | 0.886 | 0.792–0.990 |
| RV-RA gradient (TTE) | 0.224 | 1.035 | 0.979–1.094 |
| LV mass index (CMR) | 0.121 | 1.010 | 0.997–1.023 |
| T1 mapping (CMR) | 0.133 | 1.011 | 0.997–1.026 |
| GWI | 0.020 | 0.999 | 0.997–1.000 |
| GWE | 0.186 | 0.961 | 0.907–1.019 |
| GWW | 0.469 | 1.002 | 0.997–1.007 |
| GCW | 0.019 | 0.999 | 0.997–1.000 |
Myocardial Work and LGE in CMR in HCM
Type of funding source: None
