Myocardial constructive work is impaired in hypertrophic cardiomyopathy and predicts left ventricular fibrosis

Abstract : BACKGROUND: The estimation of myocardial work by pressure strain loops (PSLs) is a totally new non-invasive approach to assess myocardial performance, and its role in patients with hypertrophic cardiomyopathy is unknown. The aims of the present study are therefore: (a) to compare myocardial work in patients with non-obstructive hypertrophic cardiomyopathy (HCM) and in a subset of age-matched healthy controls and (b) to assess the correlation between myocardial work and left ventricular (LV) fibrosis.DESIGN: Eighty-two patients with non-obstructive HCM (58 ± 14 years) and 20 age-matched healthy subjects (58 ± 7 years, P = 0.99) underwent standard and speckle-tracking echocardiography to assess myocardial dimensions and deformation parameters. PSLs analysis was used to estimate global myocardial constructive work (GCW) and wasted work (GWW). LV fibrosis was estimated at cardiac magnetic resonance (CMR) by qualitative assessment of late gadolinium enhancement (LGE), and significant fibrosis was defined as LGE in ≥2 LV segments.RESULTS: Global constructive work (1599 ± 423 vs 2248 ± 249 mm Hg%, P < 0.0001) was significantly reduced in HCM compared to the control group. No difference was observed in GWW (141 ± 125 vs 101 ± 88 mm Hg%, P = 0.18) and LV ejection fraction (LVEF) (63 ± 13 vs 66 ± 4% P = 0.17) between the two groups. In HCM, GCW was the only predictor of LV fibrosis at multivariable analysis (OR 1.01, 95% CI: 0.99-1.08, P = 0.04). A cutoff value of 1623 mm Hg% (AUC 0.80, 95% CI: 0.66-0.93, P < 0.0001) was able to predict myocardial fibrosis with a good sensitivity and fair specificity (82% and 67%, respectively).CONCLUSIONS: Global constructive work is significantly reduced in HCM despite normal LVEF and is associated with the LV fibrosis as assessed by LGE.
Complete list of metadatas

Cited literature [35 references]  Display  Hide  Download

https://hal-univ-rennes1.archives-ouvertes.fr/hal-01975570
Contributor : Laurent Jonchère <>
Submitted on : Friday, March 22, 2019 - 2:13:32 PM
Last modification on : Friday, June 21, 2019 - 11:16:31 AM
Long-term archiving on : Sunday, June 23, 2019 - 2:58:44 PM

File

Galli-2018-Myocardial construc...
Files produced by the author(s)

Identifiers

Collections

Citation

Elena Galli, Emilie Vitel, Frédéric Schnell, Virginie Le Rolle, Arnaud Hubert, et al.. Myocardial constructive work is impaired in hypertrophic cardiomyopathy and predicts left ventricular fibrosis. Echocardiography, Wiley, 2018, 36 (1), pp.74-82. ⟨10.1111/echo.14210⟩. ⟨hal-01975570⟩

Share

Metrics

Record views

120

Files downloads

73