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Updated: Jun 14, 2026
Ultrasonic Assessment of Myocardial Microstructure
Published on: January 14, 2014
Non sustained ventricular tachycardia in hypertrophic cardiomyopathy and new ultrasonic derived parameters
Giovanni Di Salvo1, Giuseppe Pacileo, Giuseppe Limongelli
1Second University of Naples, Chair of Cardiology, Naples, Italy. giodisal@yahoo.it
Insights
Ultrasonography can identify hypertrophic cardiomyopathy (HCM) patients at higher risk for nonsustained ventricular tachycardia (NSVT). Reduced longitudinal strain in over three left ventricular segments predicts NSVT with high accuracy.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Electrophysiology
Background:
- Sudden cardiac death in hypertrophic cardiomyopathy (HCM) is linked to ventricular tachyarrhythmia.
- Myocyte disarray, fibrosis, and activation inhomogeneity contribute to HCM arrhythmias.
- Tissue synchronization imaging (TSI) measures regional delay; 2D strain detects fibrosis.
Purpose of the Study:
- To evaluate the relationship between novel ultrasound parameters and nonsustained ventricular tachycardia (NSVT) in HCM patients.
- To identify ultrasonic markers for predicting NSVT risk in hypertrophic cardiomyopathy.
Main Methods:
- Ninety-three HCM patients and 30 with hypertensive LV hypertrophy underwent echocardiography, TSI, and 2D strain.
- Patients were followed for 2 years with 3-monthly Holter monitoring.
- The primary endpoint was the occurrence of NSVT.
Main Results:
- Twenty-four percent of HCM patients experienced NSVT.
- NSVT patients had higher maximal LV thickness and N-terminal pro-brain natriuretic peptide levels.
- Reduced longitudinal strain (>3 LV segments with strain >= -10%) independently predicted NSVT (AUC 0.944).
Conclusions:
- Bedside ultrasound tools can identify HCM patients at increased risk for NSVT.
- Longitudinal 2D strain analysis offers high sensitivity and specificity for NSVT risk stratification.
- This non-invasive method aids in recognizing high-risk HCM patients.
Background:
The mechanism of sudden death in hypertrophic cardiomyopathy (HCM) is ventricular tachyarrhythmia emanating from myocyte disarray, fibrosis, and inhomogeneity in intramyocardial activation. Tissue synchronization imaging (TSI) allows the measurement of regional delay, while two-dimensional strain can be used to identify myocardial fibrosis. The aim of this study was to assess the relationship between new ultrasonically derived parameters and nonsustained ventricular tachycardia (NSVT) in patients with HCM.
Methods:
Ninety-three patients with HCM (mean age, 36 +/- 16 years) and 30 patients with hypertension with secondary left ventricular (LV) hypertrophy (mean age, 42 +/- 10 years; 65% men) were studied. All underwent standard echocardiographic, TSI, and two-dimensional strain examinations. Patients were followed every 3 months for 2 years. Holter monitoring was performed every 3 months. The primary endpoint was the occurrence of NSVT.
Results:
Twenty-four patients (26%) had >or=1 episode of NSVT. Patients with NSVT had a higher value of maximal LV thickness (22 +/- 6 vs 19 +/- 5 mm, P = .04). There were no significant associations between NSVT on Holter monitoring and LV outflow gradient, New York Heart Association class, syncope, and medical therapy. N-terminal pro-brain natriuretic peptide values were significantly (P = .01) higher in patients with NSTV (1034 +/- 1088 vs 561 +/- 593 pg/mL). Patients with HCM and NSVT had (1) similar values on TSI-studied parameters to patients without NSVT, (2) significant reductions in basal and mid septal strain and in basal anterior-septal strain, and (3) more frequently peak systolic strain >or= -10% (P < .0001). In multivariate analysis, the presence of >3 LV segments with longitudinal two-dimensional strain >or= -10% (sensitivity, 81%; specificity, 97.1%; area under the curve, 0.944; P < .0001) was an independent predictor of NSVT.
Conclusions:
Using a simple, inexpensive, easily available, and bedside-usable tool, it was possible to recognize with good sensitivity and specificity patients with HCM at higher risk for NSVT.
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