Basal Ventricular Septal Hypertrophy in Systemic Hypertension

Lončarić, Filip; Nunno, L; Mimbrero, M; Marciniak, Maciej; Fernandes, João Filipe; Tirapu, L; Fabijanović, Dora; Sanchís, Laura; Doltra, Adelina; Čikeš, Maja; Lamata, Pablo; Bijnens, Bart; Sitges, Marta

doi:10.1016/j.amjcard.2020.01.045

Cited by 29 publications

(41 citation statements)

References 24 publications

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“…The echocardiographic finding of basal septal hypertrophy has been shown to be a morphological marker of increased afterload in arterial hypertension ( 30 , 31 ) Here intra-ventricular heterogeneity is the consequence of heterogeneous wall stress distribution in response to elevated blood pressure. In an average heart, the septum has a greater radius of curvature compared to the free wall ( 32 , 33 ), leading to a disproportionately higher wall stress in the basal parts in the setting of high systemic pressure ( 33 ).…”

Section: Discussionmentioning

confidence: 99%

Etiology-Discriminative Multimodal Imaging of Left Ventricular Hypertrophy and Synchrotron-Based Assessment of Microstructural Tissue Remodeling

Lončarić

Garcia-Canadilla

García‐Álvarez

et al. 2021

Front. Cardiovasc. Med.

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Background: Distinguishing the etiology of left ventricular hypertrophy (LVH) is clinically relevant due to patient outcomes and management. Easily obtained, echocardiography-based myocardial deformation patterns may improve standard non-invasive phenotyping, however, the relationship between deformation phenotypes and etiology-related, microstructural cardiac remodeling has not been reported. Synchrotron radiation-based X-ray phase-contrast imaging (X-PCI) can provide high resolution, three-dimensional (3D) information on myocardial microstructure. The aim of this pilot study is to apply a multiscale, multimodality protocol in LVH patients undergoing septal myectomy to visualize in vivo and ex vivo myocardial tissue and relate non-invasive LVH imaging phenotypes to the underlying synchrotron-assessed microstructure.Methods and findings: Three patients (P1-3) undergoing septal myectomy were comprehensively studied. Medical history was collected, and patients were imaged with echocardiography/cardiac magnetic resonance prior to the procedure. Myocardial tissue samples obtained during the myectomy were imaged with X-PCI generating high spatial resolution images (0.65 μm) to assess myocyte organization, 3D connective tissue distribution and vasculature remodeling. Etiology-centered non-invasive imaging phenotypes, based on findings of hypertrophy and late gadolinium enhancement (LGE) distribution, and enriched by speckle-tracking and tissue Doppler echocardiography deformation patterns, identified a clear phenotype of hypertensive heart disease (HTN) in P1, and hypertrophic cardiomyopathy (HCM) in P2/P3. X-PCI showed extensive interstitial fibrosis with normal 3D myocyte and collagen organization in P1. In comparison, in P2/P3, X-PCI showed 3D myocyte and collagen disarray, as well as arterial wall hypertrophy with increased perivascular collagen, compatible with sarcomere-mutation HCM in both patients. The results of this pilot study suggest the association of non-invasive deformation phenotypes with etiology-related myocyte and connective tissue matrix disorganization. A larger patient cohort could enable statistical analysis of group characteristics and the assessment of deformation pattern reproducibility.Conclusion: High-resolution, 3D X-PCI provides novel ways to visualize myocardial remodeling in LVH, and illustrates the correspondence of macrostructural and functional non-invasive phenotypes with invasive microstructural phenotypes, suggesting the potential clinical utility of non-invasive myocardial deformation patterns in phenotyping LVH in everyday clinical practice.

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Section: Discussionmentioning

confidence: 99%

Etiology-Discriminative Multimodal Imaging of Left Ventricular Hypertrophy and Synchrotron-Based Assessment of Microstructural Tissue Remodeling

Lončarić

Garcia-Canadilla

García‐Álvarez

et al. 2021

Front. Cardiovasc. Med.

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“…BSH is defined based on the basal-to-mid septal thickness ratio of at least 1.4 in either the four-chamber (4CH) or parasternal long-axis (PLAX) view [ 7 ]. In order to classify the cohort, thicknesses in the anteroseptum and inferoseptum were manually measured during end-diastole at basal-level and mid-level in PLAX and 4CH views, respectively.…”

Section: Methodsmentioning

confidence: 99%

“…To capture the deterioration caused by hypertension, functional metrics proven to be affected by BSH [ 7 ] were studied, including local longitudinal LV septal strain, longitudinal conduit and contractile left atrial strain (as well as ratio of the two), diastolic function marker ( E / A ), and mitral annulus septal and lateral velocities. Moreover, the metrics were studied against the anatomical markers of BSH, namely LV mass, and end-diastolic and end-systolic volumes indexed to BSA.…”

Section: Methodsmentioning

confidence: 99%

Septal curvature as a robust and reproducible marker for basal septal hypertrophy

Marciniak

Gilbert

Lončarić

et al. 2021

Journal of Hypertension

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Background: Basal septal hypertrophy (BSH) is an asymmetric, localized thickening of the upper interventricular septum and constitutes a marker of an early remodelling in patients with hypertension. This morphological trait has been extensively researched because of its prevalence in hypertension, yet its clinical and prognostic value for individual patients remains undetermined. One of the reasons is the lack of a reliable and reproducible metric to quantify the presence and the extent of BSH. This article proposes the use of the curvature of the left ventricular endocardium as a robust feature for BSH characterization, and as an objective criterion to quantify current subjective ‘visual assessment’ of the presence of sigmoidal septum. The proposed marker, called average septal curvature, is defined as the inverse of the radius adjacent to each point of the endocardial contour along the basal and mid inferoseptal segments of the left ventricle. Method: Robustness and reproducibility were assessed on a cohort of 220 patients, including 161 hypertensive patients (32 with BSH) and 59 healthy controls. Results: The results show that compared with the conventionally used wall thickness metrics, the new marker is more reproducible (relative standard deviation of errors of 7 vs. 13%, and 8 vs. 38% for intra-observer and inter-observer variability, respectively) and better correlates to the functional parameters related to BSH, with main difference (absolute rank correlation 0.417 vs. 0.341) in local deformation changes assessed by longitudinal strain. Conclusion: Average septal curvature is a more precisely defined and reproducible metric than thickness ratios, it can be fully automated, and better infers the functional remodelling related to hypertension.

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“…The STE LV and LA strain parameters concur, showing overall decreased LV global longitudinal strain in grade I and II, and a more heterogenic regional LV deformation with basal impairment in grade III. LA strain adds incremental value to the finding of LA enlargement, reflecting underlying atrial functional dynamics 33 . The three phases of the atrial cycle—reservoir, conduit, and pump function—are reflected in corresponding LA strain measures—reservoir, conduit, and contractile strain.…”

Section: Assessing Function In Challenging Patients—the Limitations Omentioning

confidence: 99%

“…The first case is a patient presenting with elevated blood pressure at examination, which can influence the relaxation of the LV. This can be objectively quantified with the LV deformation curves, showing a post‐systolic motion in the basal septum (ie, a pattern associated with elevated blood pressure and reflecting delayed LV relaxation 33,34 ); whereas the LA strain reflects a relatively preserved atrial function. Integration of clinical and echo data in the second case reveals long‐standing moderate primary mitral regurgitation‐related LV hypertrophy and preserved EF.…”

Section: Assessing Function In Challenging Patients—the Limitations Omentioning

confidence: 99%

Comprehensive data integration—Toward a more personalized assessment of diastolic function

et al. 2020

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Background and aim The main challenge of assessing diastolic function is the balance between clinical utility, in the sense of usability and time‐efficiency, and overall applicability, in the sense of precision for the patient under investigation. In this review, we aim to explore the challenges of integrating data in the assessment of diastolic function and discuss the perspectives of a more comprehensive data integration approach. Methods Review of traditional and novel approaches regarding data integration in the assessment of diastolic function. Results Comprehensive data integration can lead to improved understanding of disease phenotypes and better relation of these phenotypes to underlying pathophysiological processes—which may help affirm diagnostic reasoning, guide treatment options, and reduce limitations related to previously unaddressed confounders. The optimal assessment of diastolic function should ideally integrate all relevant clinical information with all available structural and functional whole cardiac cycle echocardiographic data—envisioning a personalized approach to patient care, a high‐reaching future goal in medicine. Conclusion Complete data integration seems to be a long‐lasting goal, the way forward in diastology, and machine learning seems to be one of the tools suited for the challenge. With perpetual evidence that traditional approaches to complex problems may not the optimal solution, there is room for a steady and cautious, and inherently very exciting paradigm shift toward novel diagnostic tools and workflows to reach a more personalized, comprehensive, and integrated assessment of cardiac function.

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Basal Ventricular Septal Hypertrophy in Systemic Hypertension

Cited by 29 publications

References 24 publications

Etiology-Discriminative Multimodal Imaging of Left Ventricular Hypertrophy and Synchrotron-Based Assessment of Microstructural Tissue Remodeling

Etiology-Discriminative Multimodal Imaging of Left Ventricular Hypertrophy and Synchrotron-Based Assessment of Microstructural Tissue Remodeling

Septal curvature as a robust and reproducible marker for basal septal hypertrophy

Comprehensive data integration—Toward a more personalized assessment of diastolic function

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