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Use of strain imaging in detecting segmental dysfunction in patients with hypertrophic cardiomyopathy
Hua Yang1, Jing Ping Sun, Harry M Lever
1Department of Cardiology, The Cleveland Clinic Foundation, Clevelnad OH 44195, USA.
Insights
Regional systolic function is impaired in hypertrophic cardiomyopathy (HCM) patients, with reduced myocardial Doppler strain (epsilon) observed in the midseptum. This dysfunction correlates with septal hypertrophy, highlighting a potential diagnostic approach.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Left ventricular hypertrophy in hypertrophic cardiomyopathy (HCM) is heterogeneous.
- Global left ventricular function has been the focus of prior echocardiographic studies.
- Myocardial Doppler strain (epsilon) imaging quantifies regional myocardial motion.
Purpose of the Study:
- To characterize regional left ventricular systolic function in HCM patients.
- To utilize myocardial Doppler strain (epsilon) imaging for this assessment.
Main Methods:
- 31 patients with asymmetric septal hypertrophy and HCM were studied.
- 41 age-matched healthy individuals served as controls.
- Regional longitudinal axial systolic epsilon was measured in septal and lateral wall segments.
Main Results:
- HCM patients showed reduced septal epsilon (-10.3%) compared to controls (-19.4%).
- Midseptal epsilon in HCM patients was significantly lower than basal/apical septum and midlateral wall.
- Midseptal epsilon correlated significantly with intraventricular septum to posterior wall thickness ratio (r=0.81).
Conclusions:
- Midseptal longitudinal epsilon is markedly decreased or reversed in HCM, linked to septal hypertrophy.
- Myocardial Doppler epsilon imaging offers a novel method to quantify regional systolic dysfunction in HCM.
Background:
The distribution and magnitude of left ventricular hypertrophy are not uniform in patients with hypertrophic cardiomyopathy (HCM). Previous echocardiographic studies have focused on global left ventricular function. Recently, myocardial Doppler strain (epsilon) imaging, a newly developed technique, has allowed the quantification of regional myocardial motion. The aim of this study was to characterize regional left ventricular systolic function by myocardial Doppler epsilon imaging in patients with HCM.
Methods:
Included in this study were 31 patients with asymmetric septal hypertrophy and HCM, and 41 age-matched healthy patients. Regional longitudinal axial systolic epsilon was assessed at the basal, mid, and apical segments of the septal and lateral walls and compared between both groups.
Results:
Patients with HCM had reduced epsilon at the ventricular septum (-10.3 +/- 5.7%) compared with control patients (-19.4 +/- 3.3%, P <.001). In the HCM group, epsilon in the midseptum (-1.3 +/- 8.2%) was significantly less than at the basal (-12.2 +/- 8.7%, P <.01) and apical septum (-17.3 +/- 10.4%, P <.01), and was also less than at the midlateral wall (-9.4 +/- 5.3%, P <.05). There was a significant correlation between midseptal epsilon and intraventricular septum to posterior wall thickness ratio (r = 0.81, P <.001).
Conclusion:
Midseptal longitudinal epsilon was markedly decreased, even reversed in patients with HCM (paradoxic longitudinal systolic expansion), which was directly related to the degree of septal hypertrophy. Myocardial Doppler epsilon imaging could offer a unique approach to quantify regional systolic dysfunction in these patients.