Right ventricular function in hypertrophic cardiomyopathy: A speckle tracking echocardiography study

Abstract

Objective:The aim of this study was to explore right ventricular (RV) mechanical function in patients with hypertrophic cardiomyopathy (HCM) by 2-D speckle tracking echocardiography (2-D-STE).Methods:Forty-three patients with HCM (mean age 48, 17 females) and 40 healthy subjects were consecutively included in this cross-sectional study. The diagnosis of HCM was based on the presence of typical clinical, electrocardiographic (ECG), and echocardiographic features. Patients with LV systolic impairment, significant valvular disease, history of coronary artery disease, hypertension, malignancy, and chronic obstructive pulmonary disease were excluded. Right and left ventricular (LV) function was assessed by tissue Doppler imaging (TDI) and 2-D-STE. Hypertrophic cardiomyopathy patients were divided into two groups according to ACC/ESC guidelines (LVOT gradient below and above 30 mm Hg). Student t-test was used to compare differences between groups. Non-parametric tests (Mann-Whitney U) were used in cases of abnormal distribution.Results:Hypertrophic cardiomyopathy patients had a significantly larger right atrium and RV diameters compared to controls. Mean pulmonary artery pressures (mPAB) were significantly higher in HCM patients (19.01±13.09 mm Hg vs. 8.40±4.50 mm Hg; p<0.001). Although RV Sm measure-ments were similar, RV strain measurements (-28.51±5.36% vs. -32.06±7.65%; p=0.016) were significantly lower in HCM patients. Left ventricular global longitudinal, radial, and circumferential strain values were also significantly different between the two groups (-20.50±3.58% vs. -24.12±3.40%; p<0.001, 38.18±12.67% vs. 44.80±10.15%; p=0.012, -21.94±4.28% vs. -23.91±3.95%; p=0.036 consecutively). Rotational movement of LV in each apical, mid-, and basal left ventricular segment was determined, and only mid-ventricular rotation of the HCM patients was more clockwise (-1.71±2.16 ° vs. 0.04±1.72 p<0.001). Although mPAP measurements were higher in HCM patients with significant LVOT obstruction (21.52±13.26 mm Hg vs. 12.31±10.53 mm Hg; p=0.049), none of the other TDI or 2-D-STE parameters was significantly different between groups.Conclusion:Speckle tracking echocardiography-derived right ventricular systolic function is impaired in HCM patients when compared with healthy subjects. However, RV systolic function is not affected form LVOT obstruction and left ventricular rotation dynamics in HCM patients.

Nonalcoholic Steatohepatitis Score is an Independent Predictor of Right Ventricular Dysfunction in Patients with Nonalcoholic Fatty Liver Disease

“…Novel techniques such as two-dimensional (2D) speckle-tracking echocardiography (STE) provide a global approach to LV and RV myocardial mechanics, giving information about the three spatial dimensions of myocardial deformation. Previous studies have shown that 2D STE can help us to evaluate LV and RV function in several systemic diseases [13][14][15][16][17]. There is a close relationship between NAFLD and impaired LV function [18].…”

Echocardiographic Assessment of Right Ventricular Size and Function in Cats With Hypertrophic Cardiomyopathy

“…Right ventricular hypertrophy is associated with increased risk of hospitalization for congestive heart failure (CHF), thromboembolic complications, ventricular tachyarrhythmias, and sudden death;9, 10 and, severe RV hypertrophy, albeit rare, is associated with worse prognosis in humans with HCM 11. The impact of RV performance in the clinical status and outcome of humans affected with HCM also has been studied 12, 13, 14, 15. However, in cats, studies focusing on the assessment of RV size and function are limited, and it is unknown whether RV functional abnormalities occur in cats with HCM.…”

“…11 The impact of RV performance in the clinical status and outcome of humans affected with HCM also has been studied. [12][13][14][15] However, in cats, studies focusing on the assessment of RV size and function are limited, and it is unknown whether RV functional abnormalities occur in cats with HCM.…”

Left Ventricular Outflow Tract Obstruction in Hypertrophic Cardiomyopathy: The Utility of Myocardial Strain Based on Cardiac MR Tissue Tracking

“…26,27 Other small studies have not shown global myocardial strain differences between patients with and without obstruction. 17,28 Compared with healthy controls, there are regional differences in myocardial strain in HCM patients which are related to the segmental thickness, the LGE extent, the value of native T 1 , and the extracellular volume (ECV). 29,30 Thus, for HCM patients, segmental (rather than global) myocardial strain analysis may be more valuable.…”

“…The diagnosis of HCM was based on typical clinical, electrocardiographic, and imaging features, with maximal LVWT ≥15 mm (or ≥13 mm with a family history of HCM), in the absence of other cardiac or systemic diseases. 17 Patients with maximal LVOT gradient ≥30 mmHg at rest or during exercise measured by echocardiography were defined as having obstructive HCM, and those with maximal gradients <30 mmHg both at rest and during provocation were regarded as having nonobstructive HCM. 18 The 152 patients consisted of 44 obstructive HCM patients and 108 nonobstructive HCM patients.…”