Does papillary muscle free strain has predictive value in risk stratification of patients with hypertrophic cardiomyopathy?
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Updated: Aug 9, 2025
Magnetic Resonance Derived Myocardial Strain Assessment Using Feature Tracking
Published on: February 12, 2011
Atilla Koyuncu1, Cennet Yildiz1, Lutfu Ocal2
1Department of Cardiology, Bakırkoy Dr Sadi Konuk Education and Research Hospital, Istanbul, Turkey.
Insights
Papillary muscle strain is reduced in hypertrophic cardiomyopathy (HCMP) patients. This finding may aid in predicting sudden cardiac death (SCD) risk, improving patient risk stratification.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Hypertrophic cardiomyopathy (HCMP) is a complex cardiac condition.
- Papillary muscle free strain has not been previously evaluated in HCMP.
- Assessing novel markers for sudden cardiac death (SCD) risk is crucial in HCMP management.
Purpose of the Study:
- To evaluate papillary muscle free strain in HCMP patients.
- To determine if papillary muscle free strain can predict the risk of SCD in HCMP.
- To investigate the correlation between papillary muscle free strain and established SCD risk scores.
Main Methods:
- Transthoracic echocardiography with 2-D speckle tracking imaging (STI) was used.
- 55 HCMP patients and 45 controls were analyzed.
- HCMP patients were stratified into low/intermediate and high risk groups based on SCD risk score (≥6 points for high risk).
Main Results:
- HCMP patients exhibited significantly reduced global longitudinal strain and papillary muscle free strain compared to controls.
- Significantly lower global longitudinal strain and anterolateral papillary muscle (ALPM) free strain were observed in the high SCD risk group.
- Global longitudinal strain and ALPM free strain showed significant correlation with SCD risk score, with specific values demonstrating predictive capabilities for high SCD risk.
Conclusions:
- Papillary muscle free strain is reduced in HCMP patients.
- Papillary muscle free strain may serve as a valuable tool for risk stratification in HCMP.
- This metric could potentially enhance the prediction of sudden cardiac death risk in HCMP.
Background:
Papillary muscle free strain has not been evaluated previously in hypertrophic cardiomyopathy (HCMP) patients. Our aim was to evaluate free papillary muscle free strain in HCMP patients and to find whether it has a value for prediction of sudden cardiac death (SCD) risk score.
Methods:
Transthoracic echocardiography with tissue Doppler imaging, 2-D speckle tracking imaging (STI) of 55 HCMP patients and 45 controls were performed. HCMP patients were further divided into two groups according to their SCD risk score. Patients with risk score of less than 6 points constituted low/intermediate risk group, whereas patients with risk score of greater or equal to 6 points constituted high risk group.
Results:
Interventricular septum, posterior wall, and left ventricular mass index were significantly higher, whereas mitral E/A ratio was significantly lower in HCMP patients compared to controls. Longitudinal apical 4C, 2C, 3C, global longitudinal LV strain, anterolateral papillary muscle (ALPM), posteromedial papillary muscle (PMPM) free strain were significantly reduced in HCMP group compared to control group. Global longitudinal strain and ALPM free strain were significantly lower in patients with high SCD risk score (-14.6 (-17.4 - -13.1) vs -11.6 (-13.2 - -10.1), p = 0.001 and -17.1 (-20.3 - -14.0) vs -9.2 (-12.6 - -7.5), p<0.001, respectively. Global longitudinal strain and ALPM free strain were statistically significantly correlated with SCD risk score (r = 0.480, p<0.001 and r = 0.462, p<0.001, respectively). Global longitudinal strain value of -12.60% had a sensitivity of 73.3% and specificity of 82.5% for predicting high SCD risk score (AUC: 0.787, 95% CI: 00.643-0.930, p = 0.001). ALPM free strain value of -12.95% had 66.7% sensitivity and 77.5% specificity for predicting high SCD risk score (AUC: 0.766, 95% CI: 0.626-0.905, p = 0.003).
Conclusion:
Papillary muscle free strain was reduced in HCMP patients. It might be used in risk stratification of these patients.
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