Association Between Regional Ventricular Function and Myocardial Fibrosis in Hypertrophic Cardiomyopathy Assessed by Speckle Tracking Echocardiography and Delayed Hyperenhancement Magnetic Resonance Imaging

Popović, Zoran B.; Kwon, Deborah; Mishra, Micky; Buakhamsri, Adisai; Greenberg, Neil L.; Flamm, Scott D.; Thomas, James D.; Lever, Harry M.; Desai, Milind Y.

doi:10.1016/j.echo.2008.09.011

Cited by 214 publications

(139 citation statements)

References 31 publications

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“…STE has been used to gain further insight into the pathophysiology of cardiac ischemia and infarction, and several primary diseases of the myocardium, such as hypertrophic or diabetic cardiomyopathy. [16][17][18] It has recently been appreciated that STE can also be used to identify areas of myocardial fibrosis, [19][20][21][22][23][24] one of the hallmarks of UC. This prompted us to evaluate in an animal study whether STE can detect early changes of left ventricular function and correlates with histologically determined severity of myocardial fibrosis in rat models of UC.…”

mentioning

confidence: 99%

Speckle Tracking Echocardiography Detects Uremic Cardiomyopathy Early and Predicts Cardiovascular Mortality in ESRD

Kramann¹,

Erpenbeck²,

Schneider

et al. 2014

Journal of the American Society of Nephrology

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Cardiovascular mortality is high in ESRD, partly driven by sudden cardiac death and recurrent heart failure due to uremic cardiomyopathy. We investigated whether speckle-tracking echocardiography is superior to routine echocardiography in early detection of uremic cardiomyopathy in animal models and whether it predicts cardiovascular mortality in patients undergoing dialysis. Using speckle-tracking echocardiography in two rat models of uremic cardiomyopathy soon (4-6 weeks) after induction of kidney disease, we observed that global radial and circumferential strain parameters decreased significantly in both models compared with controls, whereas standard echocardiographic readouts, including fractional shortening and cardiac output, remained unchanged. Furthermore, strain parameters showed better correlations with histologic hallmarks of uremic cardiomyopathy. We then assessed echocardiographic and clinical characteristics in 171 dialysis patients. During the 2.5-year follow-up period, ejection fraction and various strain parameters were significant risk factors for cardiovascular mortality (primary end point) in a multivariate Cox model (ejection fraction hazard ratio [HR], 0.97 [95% confidence interval (95% CI), 0.95 to 0.99; P=0.012]; peak global longitudinal strain HR, 1.17 [95% CI, 1.07 to 1.28; P,0.001]; peak systolic and late diastolic longitudinal strain rates HRs, 4.7 [95% CI, 1.23 to 17.64; P=0.023] and 0.25 [95% CI, 0.08 to 0.79; P=0.02], respectively). Multivariate Cox regression analysis revealed circumferential early diastolic strain rate, among others, as an independent risk factor for all-cause mortality (secondary end point; HR, 0.43; 95% CI, 0.25 to 0.74; P=0.002). Together, these data support speckle tracking as a postprocessing echocardiographic technique to detect uremic cardiomyopathy and predict cardiovascular mortality in ESRD.

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confidence: 99%

Speckle Tracking Echocardiography Detects Uremic Cardiomyopathy Early and Predicts Cardiovascular Mortality in ESRD

Kramann¹,

Erpenbeck²,

Schneider

et al. 2014

Journal of the American Society of Nephrology

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“…[11][12][13][14] In our study, patients with hypertrophic cardiomyopathy had decreased strain in all 3 components despite a preserved left ventricular ejection fraction, and the longitudinal strain was reduced even further in the patients with hypertrophic cardiomyopathy with noncompaction compared to those without noncompaction, indicating that segmental myocardial function was influenced by the presence of coexistent subtle noncompaction of the left ventricle in patients with hypertrophic cardiomyopathy. Previous studies performed in patients with hypertrophic cardiomyopathy showed decreased segmental left ventricular function, [11][12][13][14] and other studies conducted in patients with isolated left ventricular noncompaction showed the influence of the severity of noncompaction, defined as the number of segments affected by noncompaction and the noncompaction to compaction ratio, on left ventricular function and outcomes, 6,7 but the association between left ventricular function and more subtle noncompaction of the left ventricle found in patients with hypertrophic cardiomyopathy has not been fully elucidated. A recent study by Bellavia et al 8 showed that left ventricular longitudinal, circumferential, and radial strain as assessed by speckle-tracking imaging is impaired in patients with isolated left ventricular noncompaction compared to controls, and lower longitudinal strain is accompanied by a lower left ventricular ejection fraction.…”

Section: Strain In Hypertrophic Cardiomyopathy and Influence Of Coeximentioning

confidence: 78%

“…[8][9][10] Furthermore, it has been shown that the total number of segments affected by noncompaction and the noncompaction to compaction ratio in patients with left ventricular noncompaction were independent predictors of left ventricular systolic dysfunction, and a greater number of segments with noncompaction was statistically associated with poorer outcomes, such as a low ejection fraction, death, and heart transplantation. 6,7 Although several studies showed depressed segmental left ventricular function in patients with hypertrophic cardiomyopathy, [11][12][13][14] the association between segmental left ventricular function and lesser degrees of noncompaction of the left ventricle observed in patients with hypertrophic cardiomyopathy is not fully understood. Therefore, our study was undertaken to analyze the impact of left ventricular noncompaction assessed by contrast echocardiography on regional left ventricular function evaluated by strains derived from speckle-tracking imaging in patients with hypertrophic cardiomyopathy.…”

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confidence: 99%

Evaluation of Subtle Myocardial Noncompaction by Contrast Echocardiography in Patients With Hypertrophic Cardiomyopathy and Its Relationship With Regional Ventricular Systolic Dysfunction

Chün

Deng

Zhu

et al. 2012

Journal of Ultrasound in Medicine

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Methods-Speckle-tracking imaging and contrast echocardiography were performed in 40 patients with hypertrophic cardiomyopathy. Subtle noncompaction of the left ventricle was defined as myocardium with more than 3 trabeculations in a single imaging plane with a noncompaction to compaction ratio of greater than 0.4 and less than 2.0.Results-Among 647 segments, noncompaction was present in 46 segments (7%) in the left ventricular apex in 18 patients (45%) on the standard 2-dimensional echocardiograms and in 181 segments (27%) in 32 patients (80%) on the contrast-enhanced images. The mean number of segments affected by noncompaction ± SD was 6 ± 2. The mean noncompacted thickness was 5.6 ± 0.2 mm, and the ratio of the noncompacted to compacted layers was 1.1 ± 0.4 on the contrast-enhanced images. The global peak systolic longitudinal strain in patients with hypertrophic cardiomyopathy with noncompaction (-12.8% ± 2.8%) had a significantly lower absolute value than that in patients with hypertrophic cardiomyopathy without noncompaction (-17.4% ± 1.5%; P < .05) and healthy control participants (-20.6% ± 1.3%; P < .05). The number of segments with noncompaction and the interventricular septal thickness were both independent predictors of the global peak systolic longitudinal strain.Conclusions-Contrast echocardiography is superior to standard 2-dimensional echocardiography for detecting subtle noncompaction in patients with hypertrophic cardiomyopathy. We found that the global peak systolic longitudinal strain in patients with hypertrophic cardiomyopathy with noncompaction had a significantly lower absolute value than that in patients without noncompaction and healthy controls, indicating that the total number of segments affected by coexistent subtle noncompaction in patients with hypertrophic cardiomyopathy was an independent predictor of left ventricular systolic dysfunction.

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“…First, we did not perform cardiac MRI, which was reported to be useful to assess the extent of myocardial fibrosis and disarray [9,24,25] and might have been effective to elucidate the mechanism of the strain/strain-rate abnormalities shown in the present study. Secondly, we did not perform layer-by-layer strain/strain-rate analyses because the software algorithm of our machine did not support layer-specific analysis; such analysis may also contribute to clarifying the mechanism of the strain/strain-rate abnormalities.…”

Section: Limitationsmentioning

confidence: 99%

“…Although the left ventricular (LV) ejection fraction is usually preserved or increased in patients with hypertrophic cardiomyopathy (HCM) [1][2][3], reduced myocardial contraction, especially in the longitudinal direction, has been observed in HCM patients by tissue Doppler imaging (TDI) [4][5][6], Doppler strain-rate imaging [7] and 2-dimensional speckle tracking echocardiography (STE) [8][9][10]. On the other hand, there have been few reports on alterations in the timing of the systolic peak and the systolic waveform of the LV myocardial strain rate in patients with HCM.…”

Section: Introductionmentioning

confidence: 99%

Characteristic systolic waveform of left ventricular longitudinal strain rate in patients with hypertrophic cardiomyopathy

et al. 2016

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We analyzed the waveform of systolic strain and strain-rate curves to find a characteristic left ventricular (LV) myocardial contraction pattern in patients with hypertrophic cardiomyopathy (HCM), and evaluated the utility of these parameters for the differentiation of HCM and LV hypertrophy secondary to hypertension (HT). From global strain and strain-rate curves in the longitudinal and circumferential directions, the time from mitral valve closure to the peak strains (T-LS and T-CS, respectively) and the peak systolic strain rates (T-LSSR and T-CSSR, respectively) were measured in 34 patients with HCM, 30 patients with HT and 25 control subjects. The systolic strain-rate waveform was classified into 3 patterns ("V", "W", and "√" pattern). In the HCM group, T-LS was prolonged, but T-LSSR was shortened; consequently, T-LSSR/T-LS ratio was distinctly lower than in the HT and control groups. The "√" pattern of longitudinal strain-rate waveform was more frequently seen in the HCM group (74%) than in the control (4%) and HT (20%) groups. Similar but less distinct results were obtained in the circumferential direction. To differentiate HCM from HT, the sensitivity and specificity of the T-LSSR/T-LS ratio <0.34 and the "√"-shaped longitudinal strain-rate waveform were 85% and 63%, and 74% and 80%, respectively. In conclusion, in patients with HCM, a reduced T-LSSR/T-LS ratio and a characteristic "√"-shaped waveform of LV systolic strain rate was seen, especially in the longitudinal direction. The timing and waveform analyses of systolic strain rate may be useful to distinguish between HCM and HT.

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Association Between Regional Ventricular Function and Myocardial Fibrosis in Hypertrophic Cardiomyopathy Assessed by Speckle Tracking Echocardiography and Delayed Hyperenhancement Magnetic Resonance Imaging

Cited by 214 publications

References 31 publications

Speckle Tracking Echocardiography Detects Uremic Cardiomyopathy Early and Predicts Cardiovascular Mortality in ESRD

Speckle Tracking Echocardiography Detects Uremic Cardiomyopathy Early and Predicts Cardiovascular Mortality in ESRD

Evaluation of Subtle Myocardial Noncompaction by Contrast Echocardiography in Patients With Hypertrophic Cardiomyopathy and Its Relationship With Regional Ventricular Systolic Dysfunction

Characteristic systolic waveform of left ventricular longitudinal strain rate in patients with hypertrophic cardiomyopathy

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