Myocardial work is associated with significant left ventricular myocardial fibrosis in patients with hypertrophic cardiomyopathy

Gonçalves, António Valentim; Rosa, Sílvia Aguiar; Branco, Luísa Moura; Galrinho, A; Fiarresga, António; Lopes, Luís Rocha; Thomas, Boban; Baquero, Luís; Carmo, Miguel Mota; Ferreira, Rui Cruz

doi:10.1007/s10554-021-02186-3

Cited by 14 publications

(14 citation statements)

References 21 publications

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“…23 Furthermore, integration of the estimated LV afterload produces non-invasive work indices that represent myocardial energetics, which are progressively affected in the setting of myofiber disarray and fibrosis. 24 As expected, in ApHCM patients without RVH the LV GLS and myocardial work indices were impaired, with a mild impairment in RV GLS and a preserved free wall strain. In the RVH+ group, there was significantly greater impairment in LV mechanics and RV GLS by a relative 20 to 40% when compared with RVH−, and an abnormal RV free wall strain.…”

Section: Discussionsupporting

confidence: 68%

Right ventricular hypertrophy in apical hypertrophic cardiomyopathy

Mihos

Escolar²,

Fernandez

2023

Echocardiography

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Background Right ventricular hypertrophy (RVH+) in hypertrophic cardiomyopathy occurs in one third of patients, however, outcomes in apical hypertrophic cardiomyopathy (ApHCM) have not been described. We hypothesized that RVH+ in ApHCM is associated with more ventricular remodeling and dysfunction, and increased adverse events when compared with those without RVH (RVH−). Methods Ninety‐one ApHCM patients were retrospectively analyzed using 2D and speckle‐tracking echocardiography (64 ± 16 years old, 43% female). RVH+ was defined as wall thickness >5 mm and was present in 23 (25%). Ventricular mechanics were characterized by global longitudinal strain (GLS), RV free wall strain, and myocardial work. Results New York Heart Association functional class > II, atrial fibrillation, and prior stroke were more prevalent in RVH+. Left ventricular (LV) size and ejection fraction were similar between groups, with greater septal (17 vs. 14 mm, p = .001) and apical (20 vs. 18 mm, p = .04) wall thickness in RVH+. When compared with RVH− patients, RVH+ had worse LV GLS (−8.6 vs. −12.8%), global work index (820 vs. 1172 mmHg%) (both p < .001), and work efficiency (76 vs. 83%, p = .001), as well as RV GLS (−14 vs. −17.5%) and free wall strain (−17.3 vs. −21.3%) (both p = .02). At 3‐year follow‐up RVH+ had greater incidence of heart failure hospitalization compared with RVH− (35 vs. 7%, p = .003). RVH+ was associated with RV GLS (β = .2, p = .03), independent of clinical and echocardiographic variables. Conclusions RVH+ patients with ApHCM have worse biventricular mechanics and myocardial work, and more heart failure hospitalization, as RVH− at mid‐term follow‐up.

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Section: Discussionsupporting

confidence: 68%

Right ventricular hypertrophy in apical hypertrophic cardiomyopathy

Mihos

Escolar²,

Fernandez

2023

Echocardiography

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“…We hypothesize that ischemia secondary to CMD damages myocytes energetic metabolism culminating in worse systolic performance. Recurrent episodes of ischemia due to CMD results in myocyte death and fibrotic replacement [29], and attenuated GLS, area strain and myocardial work were shown to be related with more extensive fibrosis in HCM [30][31][32][33].…”

Section: Association Between Coronary Flow Velocity Reserve and Biven...mentioning

confidence: 99%

Blunted coronary flow velocity reserve is associated with impairment in systolic function and functional capacity in hypertrophic cardiomyopathy

Rosa¹,

Lopes²,

Branco³

et al. 2022

International Journal of Cardiology

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“…Russell et al [ 17 ] corroborated this technique against invasive LV pressure measurements, and LV PSL area exhibited a strong correlation with myocardial metabolism when evaluated on positron emission tomography. Several studies have already applied MW indices to different cardiac conditions [ 40 , 41 , 42 , 43 , 44 , 45 , 46 ].…”

Section: Discussionmentioning

confidence: 99%

Myocardial Work Brings New Insights into Left Ventricular Remodelling in Cardio-Oncology Patients

Ferreira

Mano

Cardoso

et al. 2022

IJERPH

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Serial transthoracic echocardiographic (TTE) assessment of 2D left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) are the gold standard screening methods for cancer therapeutics-related cardiac dysfunction (CTRCD). Non-invasive left ventricular (LV) pressure-strain loop (PSL) provides a novel method of quantifying myocardial work (MW) with potential advantages to evaluate the impact of cardiotoxic treatments on heart function. We prospectively assessed breast cancer female patients undergoing cancer therapy through serial monitoring by 2D and 3D TTE. Patients were evaluated at T0, T1 and T2 (before, 4–6 and 12–14 months after starting therapy, respectively). Through PSL analysis, MW indices were calculated. A total of 122 patients, with a mean age of 54.7 years, who received treatment with anthracyclines (77.0%) and anti-HER2 (75.4%) were included. During a mean follow-up of 14.9 ± 9.3 months, LVEF and GLS were significantly diminished, and 29.5% developed CTRCD. All MW indices were significantly reduced at T1 compared with baseline and tended to return to baseline values at T2. Global work index and global work efficiency showed a more pronounced variation in patients with CTRCD. The presence of more than one cardiovascular risk factor, obesity and baseline left atrium volume were predictors of changes in MW parameters. In conclusion, breast cancer treatment was associated with LV systolic dysfunction as assessed by MW, with its peak at 4–6 months and a partial recovery afterwards. Assessment of myocardial deformation parameters allows a more detailed characterization of cardiac remodelling and could enhance patient screening and selection for cardioprotective therapeutics.

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Myocardial work is associated with significant left ventricular myocardial fibrosis in patients with hypertrophic cardiomyopathy

Cited by 14 publications

References 21 publications

Right ventricular hypertrophy in apical hypertrophic cardiomyopathy

Right ventricular hypertrophy in apical hypertrophic cardiomyopathy

Blunted coronary flow velocity reserve is associated with impairment in systolic function and functional capacity in hypertrophic cardiomyopathy

Myocardial Work Brings New Insights into Left Ventricular Remodelling in Cardio-Oncology Patients

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