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Published on: January 14, 2014
Tissue Doppler imaging to predict clinical course of patients with hypertrophic cardiomyopathy
Fatih Bayrak1, Gokhan Kahveci, Bulent Mutlu
1Department of Cardiology, Yeditepe University Hospital, Kozyatagi, Istanbul, Turkey. dfatihbayrak@yahoo.com
Insights
Tissue Doppler imaging, specifically LV lateral mitral annular systolic velocity (LMSa), can predict hypertrophic cardiomyopathy (HC) patient outcomes. An LMSa velocity over 4 cm/s indicates a lower risk of clinical deterioration or death.
Area of Science:
- Cardiology
- Echocardiography
- Cardiovascular Imaging
Background:
- Hypertrophic cardiomyopathy (HC) poses risks for sudden cardiac events.
- Predictive markers for HC clinical course are crucial for risk stratification.
Purpose of the Study:
- To evaluate the utility of tissue Doppler (TD) imaging in predicting the clinical trajectory of patients with HC.
- To identify specific TD parameters associated with adverse outcomes in HC.
Main Methods:
- Prospective study of 86 HC patients followed for clinical endpoints (cardiac death, heart failure hospitalization).
- Analysis of echocardiographic parameters, including left atrium diameter, left ventricle (LV) wall thickness, LV outflow obstruction, and TD velocities.
- Statistical analysis using stepwise regression to identify independent predictors.
Main Results:
- Patients with clinical endpoints showed larger left atrium, thicker LV walls, more LV outflow obstruction, and lower LV TD velocities.
- LV outflow tract obstruction and LV lateral mitral annular systolic tissue Doppler velocity (LMSa) were independent predictors of clinical endpoints.
- An LMSa velocity of 4 cm/s demonstrated high sensitivity (75%) and specificity (88%) for predicting clinical endpoints; velocities > 4 cm/s were associated with freedom from events.
Conclusions:
- LMSa is a reliable parameter for predicting long-term clinical deterioration or death risk in HC patients.
- TD imaging, particularly LMSa, offers valuable prognostic information in hypertrophic cardiomyopathy management.
Aims:
Diastolic tissue Doppler (TD) parameters allow prediction of patients with hypertrophic cardiomyopathy (HC) at risk of sudden death, ventricular tachycardia, or cardiac arrest. The aim of this study was to assess the value of TD imaging in predicting the clinical course of patients with HC.
Methods And Results:
Eighty-six HC patients were prospectively included in the study and followed-up for clinical endpoints (cardiovascular death or hospitalization due to worsening of heart failure symptoms). Patients with clinical endpoints (n = 25) had larger left atrium diameters, thicker left ventricle (LV) walls, more often LV outflow obstruction and lower TD velocities of LV. LV outflow tract obstruction (r=0.54, R(2)=0.29, P<0.03) and LV lateral mitral annular systolic tissue Doppler velocity (LMSa) (r=0.50, R(2)=0.25, P<0.0001) were found to be independent predictors for clinical endpoints in forward stepwise regression. The best value of LMSa with the highest sensitivity (75%) and specificity (88%) was 4 cm/s for predicting clinical endpoints. Patients with LMSa velocities > 4 cm/s were significantly free of clinical endpoints.
Conclusion:
In conclusion, LMSa seems to be a reliable parameter that can be used in predicting the HC patients at risk for clinical deterioration or death at long-term follow-up.
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