Left ventricular dyssynchrony and 2D and 3D global longitudinal strain for differentiating physiological and pathological left ventricular hypertrophy

Area of Science:

• Cardiology
• Sports Medicine
• Medical Imaging

Background:

• Differentiating hypertrophic cardiomyopathy (HCM) from physiological left ventricular hypertrophy (LVH) in athletes presents diagnostic challenges.
• Athletes often exhibit increased left ventricular (LV) mass due to training, mimicking HCM.
• Accurate differentiation is crucial for appropriate management and preventing adverse outcomes.

Purpose of the Study:

• To identify parameters distinguishing HCM patients from athletes with moderate LVH (13-15mm).
• To evaluate the diagnostic accuracy of echocardiographic strain parameters, including LV dyssynchrony and global longitudinal strain (GLS).

Main Methods:

• Retrospective analysis of 100 men: 50 elite rugby players (25 with moderate LVH, 25 without), 25 HCM patients with moderate LVH, and 25 controls.
• Assessment of LV dyssynchrony using standard deviation of time to peak 2D longitudinal strain.
• Computation of 2D and 3D global strain components using speckle tracking echocardiography.

Main Results:

• LV volumes and dyssynchrony were significantly greater in athletes with moderate LVH compared to controls.
• LV dyssynchrony demonstrated high accuracy (AUC=0.92) in differentiating HCM from athletes.
• Combining LV dyssynchrony with 2D GLS improved diagnostic accuracy, with preserved 2D GLS (>18%) and no LV dyssynchrony (>48ms) effectively excluding HCM.

Conclusions:

• Left ventricular (LV) dyssynchrony, assessed by speckle tracking, is a key differentiator between HCM and athlete's heart.
• The combination of LV dyssynchrony and 2D global longitudinal strain (GLS) provides a robust method for distinguishing HCM in athletes.
• These parameters aid in excluding HCM in athletes presenting with LV hypertrophy.