Left ventricular volume predicts exercise capacity in hypertrophic cardiomyopathy

Axelsson, Anna; Iversen, Kasper; Vejlstrup, Niels; Langhoff, Lasse; Thomsen, Anna F.; Ho, Carolyn Y.; Havndrup, Ole; Kofoed, Klaus F.; Jensen, Morten Kvistholm; Bundgaard, Henning

doi:10.1016/j.ijcard.2015.11.029

Cited by 5 publications

(4 citation statements)

References 11 publications

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“…1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 Furthermore, while baseline phenotypic expression limited to LV hypertrophy did not differ between sexes, LV cavity size, considered genetically determined in HCM 33,34 , was significantly smaller in women 35 , even when indexed per body size, suggesting more severe disease involvement. A small LV cavity size, defined as an end-diastolic volume in the lowest tertile, proved to be an independent predictor of exercise capacity in our cohort, consistent with the recent report by Axelsson et al 36 . For any given value of ejection fraction, a smaller LV cavity is associated with reduced stroke volume, which may account for impaired exercise capacity.…”

Section: Discussionsupporting

confidence: 93%

“…A small LV cavity size, defined as an end-diastolic volume in the lowest tertile, proved to be an independent predictor of exercise capacity in our cohort, consistent with the recent report by Axelsson et al. 36 For any given value of ejection fraction, a smaller LV cavity is associated with reduced stroke volume, which may account for impaired exercise capacity. In addition, the combination of small cavity dimensions and LV hypertrophy may synergistically determine higher diastolic filling pressures and diastolic dysfunction during effort, emphasizing the role of exercise-induced diastolic dysfunction as a main determinant of functional capacity in HCM.…”

Section: Discussionsupporting

confidence: 92%

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Sex-related differences in exercise performance and outcome of patients with hypertrophic cardiomyopathy

Ghiselli

Marchi

Fumagalli

et al. 2020

European Journal of Preventive Cardiology

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Aims Exercise performance is known to predict outcome in hypertrophic cardiomyopathy (HCM), but whether sex-related differences exist is unresolved. We explored whether functional impairment, assessed by exercise echocardiography, has comparable predictive accuracy in females and males with HCM. Methods We retrospectively evaluated 292 HCM patients (46 ± 16 years, 72% males), consecutively referred for exercise echocardiography; 242 were followed for 5.9 ± 4.2 years. Results Peak exercise capacity was 6.5 ± 1.6 metabolic equivalents (METs). Sixty patients (21%) showed impaired exercise capacity (≤5 METs). Exercise performance was reduced in females, compared with males (5.6 ± 1.6 vs 6.9 ± 1.5 METs, p < 0.001; peak METs ≤ 5 in 40% vs 13%, p < 0.001), largely driven by a worse performance in women >50 years of age. At multivariable analysis, female sex was independently associated with impaired exercise capacity (odds ratio: 4.67; 95% confidence interval (CI): 1.83–11.90; p = 0.001). During follow-up, 24 patients (10%) met the primary endpoint (a combination of cardiac death, heart failure requiring hospitalization, sustained ventricular tachycardia, appropriate implantable cardioverter defibrillator discharge, resuscitated sudden cardiac death and cardioembolic stroke). Event-free survival was reduced in females ( p = 0.035 vs males). Peak METs were inversely related to outcome in males (hazard ratio (HR) per unit increase: 0.57; 95% CI: 0.39–0.84; p = 0.004) but not in females (HR: 1.22; 95% CI: 0.66–2.24; p = 0.53). Conclusions Female patients with HCM showed significant age-related impairment in functional capacity compared with males, particularly evident in post-menopausal age groups. While women were at greater risk of HCM-related complications and death, impaired exercise capacity predicted adverse outcome only in men. These findings suggest the need for sex-specific management strategies in HCM.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 92%

Sex-related differences in exercise performance and outcome of patients with hypertrophic cardiomyopathy

Ghiselli

Marchi

Fumagalli

et al. 2020

European Journal of Preventive Cardiology

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“…Previous studies have shown that the LVEDV index is regarded as an independent predictor of low exercise capacity in patients with HCM ( 23 ), and chamber stiffness is in part determined by mass/volume ratio; diastolic function has been shown to be better in patients with a large ventricular volume (eccentric hypertrophy) than in those with smaller left ventricular volumes (concentric hypertrophy) ( 24 ). In our study, patients with NYHA classification III/IV had significantly lower left ventricular volume index values ( Fig.…”

Section: Discussionmentioning

confidence: 99%

B antigen of blood type is associated with worse NYHA classification in male patients with hypertrophic cardiomyopathy

Jiang¹

2018

Anatol J Cardiol

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Objective:ABO blood type is associated with cardiovascular diseases. Several studies have suggested sex-related differences in both hypertrophic cardiomyopathy (HCM) clinical features and ABO blood type. However, few data are available regarding the relationship between ABO blood type and HCM clinical features. We aimed to analyze the relationship between ABO blood type and HCM clinical features, and the potential effects of sex on these relationship.Methods:A total of 549 patients with HCM were enrolled consecutively. Left ventricular outflow tract gradients at rest (LOVTG-R) were measured by echocardiography. Left ventricular end-diastolic dimension, interventricular septum, left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and left ventricular mass (LVM) were assessed using cardiovascular magnetic resonance imaging.Results:Compared with the non-B antigen group, patients with B antigen had significantly higher LOVTG-R and LVEF values, worse New York Heart Association (NYHA) classification, lower left ventricular volume index values, as well as no difference in LVM index values. After adjustments for sex, male patients with B antigen still had higher LOVTG-R values and frequency of NYHA classification III/IV as well as lower LVEDV and LVESV index values. These differences were not present in female patients. Additionally, patients with NYHA classification III/IV had lower LVEDV index values.Conclusion:In males, not females, patients with HCM with blood type B antigens exhibited worse cardiac functional capacity, higher LOVTG-R values, and lower left ventricular volume index values. These relationships are a potential indicator for clinical prevention. We speculate that rehydration is more efficient in relieving symptoms in male patients with HCM with B antigens.

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“…Since LV volume is a commonly used clinical indicator for the assessment of progression of cardiac diseases ( 32 , 33 ), the ability to segment LV volumes accurately and rapidly is critical to patient assessment ( 34 ). Therefore, a volume-based DL segmentation could become a new metric for comparing the image quality of CMR images from various reconstruction and/or acquisition methods.…”

Section: Discussionmentioning

confidence: 99%

Deep learning-based left ventricular segmentation demonstrates improved performance on respiratory motion-resolved whole-heart reconstructions

et al. 2023

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IntroductionDeep learning (DL)-based segmentation has gained popularity for routine cardiac magnetic resonance (CMR) image analysis and in particular, delineation of left ventricular (LV) borders for LV volume determination. Free-breathing, self-navigated, whole-heart CMR exams provide high-resolution, isotropic coverage of the heart for assessment of cardiac anatomy including LV volume. The combination of whole-heart free-breathing CMR and DL-based LV segmentation has the potential to streamline the acquisition and analysis of clinical CMR exams. The purpose of this study was to compare the performance of a DL-based automatic LV segmentation network trained primarily on computed tomography (CT) images in two whole-heart CMR reconstruction methods: (1) an in-line respiratory motion-corrected (Mcorr) reconstruction and (2) an off-line, compressed sensing-based, multi-volume respiratory motion-resolved (Mres) reconstruction. Given that Mres images were shown to have greater image quality in previous studies than Mcorr images, we hypothesized that the LV volumes segmented from Mres images are closer to the manual expert-traced left ventricular endocardial border than the Mcorr images.MethodThis retrospective study used 15 patients who underwent clinically indicated 1.5 T CMR exams with a prototype ECG-gated 3D radial phyllotaxis balanced steady state free precession (bSSFP) sequence. For each reconstruction method, the absolute volume difference (AVD) of the automatically and manually segmented LV volumes was used as the primary quantity to investigate whether 3D DL-based LV segmentation generalized better on Mcorr or Mres 3D whole-heart images. Additionally, we assessed the 3D Dice similarity coefficient between the manual and automatic LV masks of each reconstructed 3D whole-heart image and the sharpness of the LV myocardium-blood pool interface. A two-tail paired Student’s t-test (alpha = 0.05) was used to test the significance in this study.Results & DiscussionThe AVD in the respiratory Mres reconstruction was lower than the AVD in the respiratory Mcorr reconstruction: 7.73 ± 6.54 ml vs. 20.0 ± 22.4 ml, respectively (n = 15, p-value = 0.03). The 3D Dice coefficient between the DL-segmented masks and the manually segmented masks was higher for Mres images than for Mcorr images: 0.90 ± 0.02 vs. 0.87 ± 0.03 respectively, with a p-value = 0.02. Sharpness on Mres images was higher than on Mcorr images: 0.15 ± 0.05 vs. 0.12 ± 0.04, respectively, with a p-value of 0.014 (n = 15).ConclusionWe conclude that the DL-based 3D automatic LV segmentation network trained on CT images and fine-tuned on MR images generalized better on Mres images than on Mcorr images for quantifying LV volumes.

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Left ventricular volume predicts exercise capacity in hypertrophic cardiomyopathy

Cited by 5 publications

References 11 publications

Sex-related differences in exercise performance and outcome of patients with hypertrophic cardiomyopathy

Sex-related differences in exercise performance and outcome of patients with hypertrophic cardiomyopathy

B antigen of blood type is associated with worse NYHA classification in male patients with hypertrophic cardiomyopathy

Deep learning-based left ventricular segmentation demonstrates improved performance on respiratory motion-resolved whole-heart reconstructions

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