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The systolic paradox in hypertrophic cardiomyopathy

Trine F Haland1,2, Nina E Hasselberg1,2, Vibeke Marie Almaas1,2

  • 1Department of Cardiology, Institute for Surgical Research and Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.

Open Heart
|July 5, 2017
PubMed

Insights

Hypertrophic cardiomyopathy (HCM) patients with left ventricular hypertrophy (LVH+) showed smaller cardiac volumes and preserved ejection fraction (EF) despite reduced global longitudinal strain (GLS). Patients without LVH (LVH-) had reduced volumes and subtle GLS changes, indicating a continuum of disease.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Genetics

Background:

  • Hypertrophic cardiomyopathy (HCM) is a genetic heart muscle disease.
  • Left ventricular hypertrophy (LVH) is a common feature of HCM.
  • The relationship between cardiac volumes, systolic function, and LVH in HCM requires further elucidation.

Purpose of the Study:

  • To investigate cardiac volumes and systolic function in HCM patients with (HCM LVH+) and without (HCM LVH-) left ventricular hypertrophy.
  • To compare these parameters with healthy individuals.
  • To explore the correlation between cardiac structure and function.

Main Methods:

  • Echocardiography was used to assess End-Diastolic Volume Index (EDVI), End-Systolic Volume Index (ESVI), and ejection fraction (EF).
  • Speckle tracking echocardiography measured Left Ventricular (LV) global longitudinal strain (GLS).
  • 180 HCM LVH+, 100 HCM LVH-, and 80 healthy individuals were included.

Main Results:

  • HCM LVH+ and HCM LVH- patients had significantly smaller EDVI and ESVI compared to healthy individuals.
  • Ejection fraction (EF) was similar across all groups, despite significantly worse GLS in HCM LVH+ and HCM LVH- patients compared to controls.
  • Maximal wall thickness (MWT) in HCM LVH+ correlated with worse GLS but not EF.

Conclusions:

  • Smaller cardiac volumes in HCM LVH+ may preserve EF despite impaired GLS, which is linked to MWT.
  • HCM LVH- patients exhibit reduced volumes and subtle GLS changes, suggesting a continuum of volumetric and systolic alterations preceding significant hypertrophy.
Abstract

Keywords:
Hypertrophic cardiomyopathyechocardiography and heart failure with preserved ejection fraction

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