Incremental Value of Apical Longitudinal Strain in Predicting High-Risk Apical Aneurysms in Patients with
Xin Hu1,2, Xueqing Cheng2, Yuwei Bao2
1Department of Medical Ultrasound, Wuhan Forth Hospital, Wuhan 430033, China.
Insights
Apical longitudinal strain average (LS-avg) can identify high-risk hypertrophic cardiomyopathy patients with apical aneurysms. This metric improves risk prediction beyond traditional scores, especially for those with low sudden cardiac death risk and small aneurysms.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Medical Diagnostics
Background:
- Apical aneurysms are critical risk markers for adverse outcomes in hypertrophic cardiomyopathy (HCM).
- Traditional sudden cardiac death (SCD) risk scores may not fully capture risk in these patients.
- Identifying novel apical features for improved risk stratification is crucial.
Purpose of the Study:
- To identify apical features associated with adverse outcomes in HCM patients with apical aneurysms.
- To evaluate the incremental predictive value of these features beyond the conventional SCD risk score.
Main Methods:
- Retrospective analysis of 65 HCM patients with apical aneurysms.
- Utilized conventional, contrast echocardiography, and speckle tracking echocardiography (STE).
- Median follow-up of 26 months; composite events analyzed using multivariate Cox regression.
Main Results:
- Abnormal apical longitudinal strain average (LS-avg) significantly increased composite event risk (HR: 1.23).
- Apical LS-avg improved risk assessment when added to SCD risk score or aneurysm diameter (NRI: 67.7% and 66.2%).
- Apical LS-avg enhanced prognostic accuracy, particularly in patients with low SCD risk (<4%) and small aneurysms (<20 mm).
Conclusions:
- Apical LS-avg is associated with increased cardiovascular event risk in HCM patients with apical aneurysms.
- Apical LS-avg can help identify high-risk individuals, especially those with low conventional risk scores and small aneurysms.
- This metric offers potential for personalized risk stratification in this specific patient cohort.
Abstract:
Background: Apical aneurysms have long been considered a critical risk marker for poor clinical outcomes in hypertrophic cardiomyopathy (HCM) individuals. This study aims to identify apical features associated with adverse outcomes and explore their incremental predictive value beyond the traditional sudden cardiac death (SCD) risk score model. Methods: From December 2019 to November 2024, 2318 HCM patients were diagnosed at Tongji Hospital. Ultimately, 65 HCM patients with apical aneurysms were included in the analysis, each having undergone conventional and contrast echocardiography, as well as speckle tracking echocardiography (STE). Results: With a median follow-up of 26 months, composite events occurred in 25 (38%) patients, while none occurred in 40 (62%). Multivariate Cox regression revealed that abnormal apical longitudinal strain average (LS-avg) significantly increased composite event risk (HR: 1.23; 95% CI: 1.02-1.48). For patients with a 5-year SCD risk score < 4% or aneurysm diameter < 20 mm, survival differed significantly between apical LS-avg ≥ -6.6% and <-6.6% (p < 0.05). Correct reclassification was 10.8% (7/65) for reduced 5-year SCD risk scores and 15.4% (10/65) for smaller aneurysms. Incorporating apical LS-avg into 5-year SCD risk score or aneurysm diameter assessment improved risk assessment (NRI: 67.7% and 66.2% for adverse event prediction). A likelihood ratio test showed that apical LS-avg enhanced prognostic accuracy in patients, with lower 5-year SCD risk scores and smaller aneurysms (all p < 0.001). Conclusions: Apical LS-avg may be associated with an increased risk of adverse cardiovascular events in HCM individuals who had apical aneurysms. On the basis of the conventional 5-year SCD risk score and aneurysm size, apical LS-avg may have the potential to be used to individually identify the high-risk group of this patient cohort, particularly among those with a 5-year SCD risk score < 4% and an aneurysm diameter < 20 mm.
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