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Background: Both fibrotic and hypertrophic changes in the left ventricular myocardium (LVM) on cardiac magnetic resonance (CMR) adversely influence peak longitudinal strain (PLS) values (absolute values) at corresponding sites on two dimensional speckle tracing transthoracic echocardiography (TTE). We hypothesized that quantitative values of PLS on TTE can differentiate LVM into the following 4 patterns in hypertrophic cardiomyopathy (HCM) patients: group 1) neither fibrotic nor hypertrophic change, group 2) no fibrotic change but hypertrophic change evident, group 3) fibrotic change present but without hypertrophic change, and group 4) both fibrotic and hypertrophic change determined by CMR.
Methods: Eighteen HCM patients were enrolled and (14 males, mean age 58 ± 17 years) underwent both 1.5 T CMR (Achieva, Philips) and TTE (Vivid E9, GE Healthcare). On TTE, PLS (absolute values) for each LVM segment among 17 lesions (as defined by American Heart Association) was calculated using Echo PAC, version 113 (GE Healthcare). Fibrotic change was defined as late gadolinium enhancement on T1 weighted images in CMR. Hypertrophic change was defined as myocardial hypertrophy with ≥13mm wall thickness on CMR. We compared regional PLS in each LVM segment stratified into groups 1-4 as mentioned above.
Results: Of 308 LVM lesions, numbers for groups 1-4 were 179, 55, 35, and 39, respectively. PLS for LVM segments in group 1 (13.5±6.7%) were significantly greater than those in group 2 (8.5±6.7%, P<0.001), group 3 (9.8±4.8%, P=0.01), and group 4 (8.5±4.7%, P<0.001). However there were no significant differences in PLS in LVM among groups 2-4.
Conclusions: Using regional PLS, we showed successful differentiation of LVM for group 1 (LVM with neither fibrotic change nor hypertrophic change) from LVM belonging to groups 2-4 in HCM patients. However it is not possible to differentiate between LVM with fibrotic change and those with hypertrophic change. Our findings have significant implications for HCM patients.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Insights From Echocardiography Use
Abstract Category: 28. Non Invasive Imaging: Echo
Presentation Number: 1291-235
- 2017 American College of Cardiology Foundation