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Updated: Aug 8, 2025
Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation
Published on: October 20, 2016
Predicting Left Ventricular Myocardial Fibrosis in Patients with Hypertrophic Cardiomyopathy by Speckle Tracking
Xin Hu1, Yuwei Bao1, Ying Zhu1
1Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Insights
Speckle tracking automated functional imaging (AFI) effectively identifies myocardial fibrosis in hypertrophic cardiomyopathy (HCM) patients. Global longitudinal strain (GLS) predicts significant fibrosis and adverse outcomes.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Hypertrophic cardiomyopathy (HCM) is a genetic heart disease often associated with myocardial fibrosis.
- Myocardial fibrosis can lead to adverse clinical outcomes, including sudden cardiac death.
- Accurate identification of myocardial fibrosis is crucial for risk stratification in HCM patients.
Purpose of the Study:
- To evaluate the predictive value of multiple strain parameters derived from speckle tracking automated functional imaging (AFI) for detecting myocardial fibrosis in HCM patients.
- To establish cutoff values for strain parameters to identify myocardial fibrosis.
- To assess the association of strain parameters with fibrosis severity and clinical outcomes.
Main Methods:
- Sixty-one HCM patients and 20 healthy controls underwent transthoracic echocardiography and cardiac magnetic resonance late gadolinium enhancement (LGE).
- Speckle tracking AFI was used to analyze multiple strain parameters, including segmental longitudinal strain (LS) and global longitudinal strain (GLS).
- A total of 1458 myocardial segments were analyzed to correlate strain parameters with LGE findings.
Main Results:
- Segments with LGE in HCM patients showed significantly lower absolute segmental LS values compared to those without LGE.
- Cutoff values for segmental LS were determined for predicting LGE in different left ventricular regions.
- Global longitudinal strain (GLS) at a cutoff of -16.5% predicted significant myocardial fibrosis with 80.9% sensitivity and 76.5% specificity.
- GLS independently predicted fibrosis severity and 5-year sudden cardiac death risk in HCM patients.
Conclusions:
- Speckle tracking AFI, using multiple strain parameters, can effectively identify left ventricular myocardial fibrosis in HCM.
- A GLS cutoff of -16.5% is indicative of significant myocardial fibrosis and may predict adverse clinical outcomes in HCM patients.
Objective:
The study was performed to explore the predictive value of multiple strain parameters for myocardial fibrosis in patients with hypertrophic cardiomyopathy (HCM) by using speckle tracking automated functional imaging (AFI).
Methods:
A total of 61 patients diagnosed with HCM were finally enrolled in this study. All patients completed transthoracic echocardiography and cardiac magnetic resonance late gadolinium enhancement (LGE) within 1 month. Twenty age- and sex-matched healthy participants were included as the control group. Multiple parameters, including segmental longitudinal strain (LS), global longitudinal strain (GLS), post-systolic index and peak strain dispersion, were automatically analyzed by AFI.
Results:
A total of 1458 myocardial segments were analyzed according to the left ventricular 18-segment model. Among the 1098 segments from HCM patients, segments with LGE had a lower absolute value of segmental LS than those without LGE (p < 0.05). The cutoff values of segmental LS for predicting positive LGE in the basal, intermediate and apical regions were -12.5%, -11.5% and -14.5%, respectively. GLS could predict significant myocardial fibrosis (≥2 positive LGE segments) at a cutoff value of -16.5% with a sensitivity of 80.9% and specificity of 76.5%. As an independent predictor of significant myocardial fibrosis, GLS was substantially associated with the severity of myocardial fibrosis and 5 years sudden cardiac death risk score in HCM patients.
Conclusion:
Speckle tracking AFI could efficiently identify left ventricular myocardial fibrosis in patients with HCM by multiple parameters. GLS predicted significant myocardial fibrosis at a cutoff value of -16.5%, which may indicate the adverse clinical outcomes in HCM patients.
