Layer-specific strain echocardiography may reflect regional myocardial impairment in patients with hypertrophic cardiomyopathy

Area of Science:

• Cardiology
• Medical Imaging
• Biomedical Engineering

Background:

• Hypertrophic cardiomyopathy (HCM) is a primary cause of sudden cardiac death.
• Assessing regional myocardial impairment in HCM is crucial for risk stratification.
• Current methods may not fully capture layer-specific cardiac mechanics.

Purpose of the Study:

• To evaluate if layer-specific strain (LSS) can identify regional myocardial impairment in HCM patients.
• To investigate the transmural gradient of longitudinal strain (TGLS) as a novel LSS-derived parameter.
• To correlate TGLS abnormalities with clinical symptoms like chest pain in HCM.

Main Methods:

• Enrolled 50 HCM patients and 30 healthy controls.
• Measured transmural gradient of longitudinal strain (TGLS) using echocardiography.
• Analyzed TGLS across basal, middle, and apical left ventricular segments.
• Utilized receiver operating characteristic (ROC) curve analysis to assess TGLS predictive value for chest pain.

Main Results:

• Healthy controls exhibited negative TGLS, with a gradient from base to apex.
• HCM patients showed significantly higher TGLS in hypertrophic segments compared to controls and normal segments.
• Abnormal TGLS (positive values) in HCM was associated with chest pain.
• A large area of abnormal TGLS (>4 segments) demonstrated moderate accuracy (73.3% sensitivity, 70.0% specificity) in predicting chest pain.

Conclusions:

• Transmural gradient of longitudinal strain (TGLS) effectively reflects regional myocardial impairment in HCM.
• Abnormal TGLS is a potential biomarker for chest pain in HCM patients.
• TGLS represents a promising novel parameter for assessing cardiac mechanics in HCM.