Myocardial Work in Apical Hypertrophic Cardiomyopathy

Peters, Matthew E.; Jan, M. Fuad; Ashraf, Muddasir; Sanders, Heather; Roemer, Sarah; Schweitzer, McKenzie; Adefisoye, James; Galazka, Patrycja; Jain, Renuka; Jahangir, Arshad; Khandheria, Bijoy K.

doi:10.1016/j.echo.2023.06.013

Cited by 4 publications

(5 citation statements)

References 22 publications

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Section: Discussionmentioning

confidence: 99%

“…Decreased ventricular mechanics and performance characterize hypertrophic cardiomyopathy, with an LV global constructive work ≥ 1730 mmHg% having been identified as a threshold for better event-free survival, and GLS > −17% being related to the extent of late gadolinium enhancement on cardiac magnetic resonance imaging [ 7 , 24 ]. More specifically, when compared with non-ApHCM phenotypes, patients with ApHCM have been shown to have greater and progressive LV impairment [ 7 , 8 ]. In a study comparing 48 ApHCM versus 69 non-ApHCM patients, the median LV GLS (−11 vs. −18%), global work index (966 vs. 1803 mmHg%), and global constructive work (1050 vs. 1998 mmHg%) (all p < 0.001) were significantly attenuated amongst the ApHCM group, which is consistent with marked subclinical LV dysfunction and abnormal myocardial energy consumption [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…More specifically, when compared with non-ApHCM phenotypes, patients with ApHCM have been shown to have greater and progressive LV impairment [ 7 , 8 ]. In a study comparing 48 ApHCM versus 69 non-ApHCM patients, the median LV GLS (−11 vs. −18%), global work index (966 vs. 1803 mmHg%), and global constructive work (1050 vs. 1998 mmHg%) (all p < 0.001) were significantly attenuated amongst the ApHCM group, which is consistent with marked subclinical LV dysfunction and abnormal myocardial energy consumption [ 7 ]. Global wasted work > 186 mmHg% has also been shown to predict adverse cardiovascular outcomes in ApHCM, with sensitivity of 93%.…”

Section: Discussionmentioning

confidence: 99%

“…At mid-term follow-up, we observed a progressive decline in LV mechanics in the ApHCM-Pure group, although a greater degree of impairment persisted in ApHCM-Mixed patients upon comparison. This adds to the characterization of ApHCM as a progressive cardiomyopathy, and, with the aforementioned discussion, suggests that ApHCM-Mixed represents a distinct subtype with more advanced ventricular dysfunction and concerns regarding observed all-cause mortality, which requires further investigation [ 7 , 8 , 11 , 12 , 13 ]. Previously identified risk factors for poor LV GLS in ApHCM include atrial fibrillation, mitral annular e’ velocity, and glomerular filtration rate, and RV hypertrophy for RV GLS [ 8 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…It accounts for approximately 20% of all hypertrophic cardiomyopathy cases, may be sporadic or inherited due to myofilament gene mutations, and has contemporaneously been shown to confer important cardiovascular morbidity [ 2 , 3 , 4 , 5 , 6 ]. Speckle-tracking strain mechanics reveal that despite a generally preserved or even hyperdynamic LV ejection fraction, patients with ApHCM have a progressive impairment of LV global longitudinal strain (GLS) and myocardial energetics, which most commonly manifests as heart failure with a preserved ejection fraction [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Interventricular Septal Involvement Is Associated with More Impaired Ventricular Function and Mechanics in Apical Hypertrophic Cardiomyopathy

Mihos,

Elajami,

Misra

et al. 2024

JCDD

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Background: The interventricular septum has an important role in bi-ventricular performance. We hypothesized that septal involvement in apical hypertrophic cardiomyopathy (ApHCM-Mixed) adversely impacts ventricular structure and function when compared with isolated apical hypertrophy (ApHCM-Pure). Methods: A total of 72 patients (ApHCM-Mixed = 36, ApHCM-Pure = 36) with serial 2D and speckle-tracking echocardiographic analyses were identified. Ventricular function and mechanics were characterized by left (LV) and right (RV) ventricular global longitudinal strain (GLS), RV free wall strain, and LV myocardial work indices, and clinical events were adjudicated. Results: Clinical characteristics were similar between groups (mean age, 66 ± 15 years; 49% female; LV ejection fraction, 68 ± 11%). The ApHCM-Mixed group had larger LV mass indexes (141 ± 39 vs. 111 ± 30 g/m2, p < 0.001), worse LV (−9.6 ± 3.1 vs. −14.4 ± 3.4%, p < 0.001) and RV GLS (−14.3 ± 6.7 vs. −19.2 ± 5.2%, p = 0.001), impaired RV free wall strain (−18.5 ± 7.4 vs. −22.4 ± 6.3%, p = 0.02), and lower LV myocardial work indices including global work index (938 ± 306 vs. 1272 ± 339 mmHg%, p < 0.001), when compared with the ApHCM-Pure group. At a mean follow-up of 3.9 years, these differences all persisted. Five deaths were observed, all occurring in the ApHCM-Mixed group (14% vs. 0, p = 0.05), and with four being cardiac-related. This subgroup had a mean LV ejection fraction of 63%, LV GLS of −8.7%, an LV global work index of 875 mmHg%, and RV free wall strain of −15.9%, indicating significant subclinical bi-ventricular dysfunction. Conclusions: ApHCM-Mixed represents a distinct morphology in hypertrophic cardiomyopathy associated with more impaired ventricular function and mechanics when compared with ApHCM-Pure.

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