Exercise Speckle-Tracking Strain Imaging Demonstrates Impaired Right Ventricular Contractile Reserve in Hypertrophic Cardiomyopathy

• Published in: International journal of cardiology Vol. 227; pp. 209 - 216
• Main Authors: D’Andrea, Antonello, Limongelli, Giuseppe, Baldini, Luca, Verrengia, Marina, Carbone, Andreina, Di Palma, Enza, Vastarella, Rossella, Masarone, Daniele, Tagliamonte, Gianluigi, Riegler, Lucia, Calabrò, Raffaele, Russo, Maria Giovanna, Bossone, Eduardo, Pacileo, Giuseppe
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.01.2017
• Subjects: Adult; Cardiomyopathy, Hypertrophic - diagnostic imaging; Cardiomyopathy, Hypertrophic - physiopathology; Cardiovascular; Case-Control Studies; Contractile reserve; Diastolic function; Echocardiography; Echocardiography, Doppler, Color; Echocardiography, Stress; Exercise stress echo; Female; Fractional Flow Reserve, Myocardial - physiology; Humans; Hypertrophic cardiomyopathy; Image Interpretation, Computer-Assisted; Linear Models; Male; Middle Aged; Multivariate Analysis; Myocardial Contraction - physiology; Observer Variation; Reference Values; Rest; Right ventricle; ROC Curve; Severity of Illness Index; Strain; Ventricular Dysfunction, Right - diagnostic imaging; Ventricular Dysfunction, Right - physiopathology; Young Adult; strain; exercise stress echo; hypertrophic cardiomyopathy; contractile reserve; right ventricle; diastolic function; Diastolic function; Hypertrophic cardiomyopathy; Right ventricle; Contractile reserve; Exercise stress echo; Strain
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2016.11.150

Abstract Aims to analyse right ventricular (RV) systolic function in patients with hypertrophic cardiomyopathy (HCM) at rest and during exercise, and its possible correlation with left ventricular(LV) morphology and function. Methods and results standard echo, exercise stress echo, and RV 2D speckle-tracking strain (2DSE) were performed in 45 patients with HCM and in 45 age- and sex-comparable healthy controls. RV global longitudinal strain (GLS) was calculated by averaging local strains along the entire right ventricle. LV mass index and IVS wall thickness were significantly increased in HCM, while LV ejection fraction, RV diameters, RV tissue Doppler systolic peak and the RV end-systolic pressure-area relationship at rest were comparable between the two groups. Conversely, all transmitral Doppler indexes were significantly impaired in HCM. In addition, RV GLS and regional peak myocardial RV strains were significantly reduced in patients with HCM (all P < 0.001). During physical effort, LV ejection fraction was comparable between the two groups. Conversely, LV E / Em ratio was significantly increased in HCM. Increase in TAPSE and RV tissue Doppler Sm peak velocity during effort were similar between the two groups. Conversely, increases of RV end-systolic pressure-area, regional and global RV strain were significantly lower in HCM patients (RV lateral strain: 10.3 ± 3.5 % of increase in HCM vs 20.5 ± 4.5 % in controls; p < 0.0001). Multivariable analysis detected independent associations of RV lateral strain at peak stress with LV IVS thickness, maximal workload during exercise, and LV E/Em ratio during effort (all p < 0.0001). An RV lateral 2DSE cut-off point of − 14% differentiated controls and HCM with an 86%sensitivity and a 92% specificity. Conclusions RV contractile reserve for HCM is impaired and this suggests that the lower resting values of RV in HCM may represent early subclinical myocardial damage, closely associated with exercise capacity.