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Hypersynchrony in sarcomeric hypertrophic cardiomyopathy: description and mechanistic approach using multimodal

Patricia Réant1,2,3,4,5, Guillaume Bonnet1,2,3,4,5, Frédérique Dubé1,2,6

  • 1Cardiology Department, Bordeaux University Hospital, Bordeaux, France.

Frontiers in Cardiovascular Medicine
|June 24, 2024
PubMed

Insights

Hypertrophic cardiomyopathy (HCM) alters left ventricular (LV) contraction, with many patients losing the normal apex-to-base delay. This hypersynchrony is linked to distinct electrical activation patterns and smaller LV dimensions, offering insights into HCM mechanics.

Area of Science:

  • Cardiology
  • Cardiac Electrophysiology
  • Cardiovascular Imaging

Background:

  • Hypertrophic cardiomyopathy (HCM) is characterized by abnormal heart muscle thickening.
  • Little is known about the interplay between mechanical contraction and electrical activation in HCM.
  • Understanding these sequences may help predict response to pacing therapies in obstructive HCM.

Purpose of the Study:

  • To compare left ventricular (LV) mechanical and electrical activation sequences in HCM patients versus healthy controls.
  • To investigate potential differences between obstructive and non-obstructive HCM.
  • To explore associations between contraction patterns and cardiac imaging parameters.

Main Methods:

  • Prospective study of 40 HCM patients (20 obstructive, 20 non-obstructive) and 20 controls.
  • Assessed LV mechanical activation using echocardiography and cardiac MRI.
  • Evaluated electrical activation with 3D electrocardiographic mapping (ECM).

Main Results:

  • Healthy controls exhibited a physiological apex-to-base delay (ABD) in contraction.
  • 18 HCM patients (45%) showed a loss of ABD (hypersynchrony), more than controls (5%).
  • Hypersynchronous HCM patients had smaller LV volumes, lower native T1 values, and a distinct ECM pattern.

Conclusions:

  • LV contraction sequence is altered in HCM, with loss of physiological ABD observed in a significant subset.
  • This altered mechanical sequence correlates with specific electrical activation patterns and smaller LV dimensions.
  • Further research is needed to clarify if these patterns reflect an electrical substrate or cardiac geometry.
Abstract

Keywords:
apex-to-base delaycardiac activationhypersynchronyhypertrophic cardiomyopathymyocardial contractionnon-invasive electrocardiographic mapping

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