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Updated: May 9, 2026
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
Strain analysis during exercise in patients with left ventricular hypertrophy: impact of etiology
Frédéric Schnell1, Erwan Donal2, Anne Bernard-Brunet3
1Department of Physiology, Université Rennes 1, Rennes, France; INSERM UMR 1099, Rennes, France; CIC-IT 804, Université Rennes 1, CHU Rennes, Rennes, France.
Insights
Higher afterload in aortic stenosis (AS) patients reduced left ventricular (LV) contractile reserve compared to hypertrophic cardiomyopathy (HCM) patients, despite similar resting characteristics. This impacts myocardial deformation during exercise.
Area of Science:
- Cardiology
- Echocardiography
- Cardiovascular Physiology
Background:
- Left ventricular (LV) systolic function can be affected by hypertrophic cardiomyopathy (HCM) and aortic stenosis (AS), even with preserved ejection fraction.
- Cardiac afterload and myocardial hypertrophy are key factors influencing myocardial deformation.
- Understanding these factors is crucial for assessing cardiac function in conditions like AS and HCM.
Purpose of the Study:
- To evaluate the relative contributions of cardiac afterload and myocardial hypertrophy to impaired myocardial deformation.
- To compare myocardial deformation at rest and during exercise in patients with AS and HCM.
- To determine the impact of increased afterload on contractile reserve.
Main Methods:
- Prospective study of 50 asymptomatic patients (25 AS, 25 HCM) using resting and exercise echocardiography.
- Two-dimensional strain imaging assessed myocardial deformations (global longitudinal and circumferential strain).
- Patients were matched for age, sex, blood pressure, LV hypertrophy, and ejection fraction; exclusion criteria applied.
Main Results:
- Resting global longitudinal strain (GLS) was similar between AS and HCM groups (-14.9% vs. -16.1%).
- During exercise, GLS decreased in AS patients but increased in HCM patients (P=.004).
- Higher afterload in AS patients, especially during exercise, correlated with reduced contractile reserve.
Conclusions:
- LV longitudinal and circumferential deformation during exercise is reduced in AS compared to HCM.
- Elevated afterload in AS patients significantly impairs contractile reserve.
- These findings highlight the distinct pathophysiological impacts of AS and HCM on LV function.
Background:
Hypertrophic cardiomyopathy (HCM) and aortic stenosis (AS) may influence left ventricular (LV) systolic function, despite preservation of LV ejection fraction. The aim of this study was to determine the relative importance of cardiac afterload and myocardial hypertrophy in the potential dysfunction of myocardial deformation, at rest and during standardized exercise.
Methods:
Patients with moderate to severe (≤ 1.5 cm(2)) asymptomatic AS and patients with HCM in sinus rhythm were prospectively studied using resting and exercise echocardiography during submaximal exercise. Myocardial deformations were assessed using two-dimensional strain. Exclusion criteria were altered LV ejection fraction (<50%), coronary artery disease, intra-LV obstruction > 30 mm Hg at rest, diastolic LV thickness ≥ 30 mm, and New York Heart Association class > II. Thus, 50 patients (25 with AS, 25 with HCM) were selected and matched for age, sex, rest and exercise blood pressure, degree of LV hypertrophy (defined by maximal wall thickness), and LV ejection fraction.
Results:
Mean resting global longitudinal strain (GLS) was -14.9 ± 4.7% in patients with AS and -16.1 ± 3.9% in those with HCM (P = .30). During exercise (mean heart rate, 110 ± 10 beats/min), mean GLS was -13.9 ± 4.2% in patients with AS and -18.1 ± 5.4% in those with HCM (P = .004). GLS decreased in patients with AS but increased in those with HCM (ΔGLS, 0.9 ± 3.1% and -1.9 ± 3.2%, respectively, P = .003). The same results were observed for global circumferential strain. Mean resting global circumferential strain was -16.4 ± 5.8% in patients with AS and -17.9 ± 4.5% in those with HCM (P = .36). During exercise, mean global circumferential strain was -13.8 ± 4.1% in patients with AS and -18.6 ± 5.3% in those with HCM (P = .011). Afterload was higher, particularly during exercise, in patients with AS than in those with HCM.
Conclusions:
Longitudinal and circumferential LV deformation during exercise was lower in patients with AS compared with those with HCM, despite similar resting characteristics. The greater afterload observed in patients with AS led to reduced contractile reserve.
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