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Interventricular Septal Involvement Is Associated with More Impaired Ventricular Function and Mechanics in Apical

Christos G Mihos1,2, Tarec K Elajami2, Deepika Misra2

  • 1Echocardiography Laboratory, Columbia University Irving Medical Center, Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL 33140, USA.

Journal of Cardiovascular Development and Disease
|March 27, 2024
PubMed

Insights

Septal involvement in apical hypertrophic cardiomyopathy (ApHCM-Mixed) leads to worse ventricular function and mechanics compared to isolated apical hypertrophy (ApHCM-Pure). This distinct ApHCM-Mixed morphology is linked to impaired bi-ventricular function and increased cardiac events.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Cardiac Mechanics

Background:

  • The interventricular septum plays a crucial role in biventricular performance.
  • Apical hypertrophic cardiomyopathy (ApHCM) presents in various forms, including isolated apical hypertrophy (ApHCM-Pure) and mixed septal involvement (ApHCM-Mixed).

Purpose of the Study:

  • To investigate the impact of septal involvement in ApHCM-Mixed on ventricular structure and function compared to ApHCM-Pure.
  • To characterize differences in ventricular mechanics and clinical outcomes between these two ApHCM subtypes.

Main Methods:

  • Serial 2D and speckle-tracking echocardiography were performed on 72 patients (36 ApHCM-Mixed, 36 ApHCM-Pure).
  • Ventricular function and mechanics were assessed using global longitudinal strain (GLS) of the left (LV) and right (RV) ventricles, RV free wall strain, and LV myocardial work indices.
  • Clinical events were adjudicated over a mean follow-up of 3.9 years.

Main Results:

  • The ApHCM-Mixed group exhibited larger LV mass indexes and significantly worse LV and RV GLS, impaired RV free wall strain, and reduced LV myocardial work indices compared to the ApHCM-Pure group.
  • These functional and mechanical differences persisted throughout follow-up.
  • Five deaths occurred exclusively in the ApHCM-Mixed group (14%), four of which were cardiac-related, indicating significant subclinical bi-ventricular dysfunction.

Conclusions:

  • ApHCM-Mixed represents a distinct morphological subtype of hypertrophic cardiomyopathy.
  • This subtype is associated with more impaired ventricular function and mechanics compared to ApHCM-Pure.
  • Septal involvement in ApHCM adversely impacts bi-ventricular performance and may be linked to poorer clinical outcomes.
Abstract

Keywords:
apical hypertrophic cardiomyopathycardiac mechanicsglobal longitudinal strainmyocardial workspeckle-tracking echocardiographystrain echocardiography

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