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Systolic function reserve using two-dimensional strain imaging in hypertrophic cardiomyopathy: comparison with
Hala Mahfouz Badran1, Naglaa Faheem, Waleed Abdou Ibrahim
1Cardiology Department, Menoufiya University, Shebin, Egypt; The BAHCM National Program, Alexandria, Egypt; Aswan Heart Center, Aswan, Egypt.
Insights
Patients with hypertrophic cardiomyopathy (HCM) exhibit reduced systolic function reserve and increased exercise-induced dyssynchrony compared to hypertension patients. Two-dimensional strain imaging during stress effectively identifies cardiovascular risk in HCM.
Area of Science:
- Cardiology
- Echocardiography
- Cardiovascular Imaging
Background:
- Patients with hypertrophic cardiomyopathy (HCM) often present with normal resting ejection fractions.
- Despite normal resting ejection fraction, HCM patients may have impaired systolic function reserves, limiting exercise capacity.
- Comparing HCM patients with hypertensive (HTN) patients helps elucidate distinct cardiac reserve differences.
Purpose of the Study:
- To investigate differences in systolic function reserve and exercise capacity between patients with HCM and HTN.
- To evaluate the utility of two-dimensional strain imaging in assessing cardiac function during exercise in these patient groups.
Main Methods:
- Utilized resting and peak exercise echocardiography with 2D strain imaging in 40 HCM patients, 20 HTN patients, and 33 controls.
- Measured longitudinal and circumferential strain, LV twist, and LV systolic dyssynchrony (standard deviation of time to peak strain).
- Calculated functional systolic reserve as the difference between peak exercise and resting values, divided by the resting value.
Main Results:
- HCM patients showed significantly lower resting longitudinal strain and strain rates, but higher resting circumferential strain and twist compared to HTN and controls.
- Functional systolic reserve was markedly attenuated in HCM patients (-23%) compared to controls (17%) and HTN patients (10%).
- Exercise significantly amplified LV dyssynchrony in HCM patients, which correlated with exercise capacity, alongside resting LV dyssynchrony and diastolic function.
Conclusions:
- HCM patients demonstrate significantly limited systolic function reserve and increased dynamic dyssynchrony during exercise compared to HTN patients.
- Two-dimensional strain imaging during stress is a promising method for identifying patients at higher cardiovascular risk.
- Findings highlight distinct pathophysiological mechanisms affecting exercise capacity in HCM versus HTN.
Background:
Although patients with hypertrophic cardiomyopathy (HCM) have normal ejection fractions at rest, the investigators hypothesized that these patients have differentially abnormal systolic function reserves, limiting their exercise capacity compared with patients with hypertension (HTN).
Methods:
Forty patients with HCM (mean age, 39.1 ± 12 years), 20 patients with HTN with LVH, and 33 healthy individuals underwent resting and peak exercise echocardiography using two-dimensional strain imaging. Peak longitudinal systolic strain (εsys) and strain rate were measured in apical views. Circumferential εsys and left ventricular (LV) twist were analyzed from short-axis views. LV systolic dyssynchrony was measured from regional longitudinal strain curves as the standard deviation of time to peak strain (time from the beginning of the Q wave on electrocardiography to peak εsys) between 12 segments. The differences between resting and peak exercise values were analyzed, and functional reserve was calculated as the difference divided by the resting value.
Results:
In patients with HCM, resting values for longitudinal εsys, systolic strain rate, early diastolic strain rate, and atrial diastolic strain rate were significantly lower, while circumferential εsys and twist were higher, compared with patients with HTN and controls (P < .0001). Functional systolic reserve increased during exercise in controls (17 ± 6%), increased to a lesser extent in patients with HTN (10 ± 16%), and was markedly attenuated in patients with HCM (-23 ± 28%) (P < .001). At peak exercise, even with augmented circumferential εsys and twist in patients with HCM (P < .01) compared with those with HTN, both remained lower than in controls (P < .001). LV dyssynchrony was amplified during exercise in patients with HCM compared with those with HTN (P < .001). Within the entire population, exercise capacity was clearly correlated with systolic functional reserve. However when taken separately, it was mainly related to resting LV dyssynchrony and diastolic function in patients with HCM, whereas it was linked to age and LV wall thickness in those with HTN.
Conclusions:
Patients with HCM have significantly limited systolic function reserve and more dynamic dyssynchrony with exercise compared with those with HTN. Two-dimensional strain imaging during stress may provide a new and reliable method to identify patients at higher cardiovascular risk.
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