Characteristic myocardial strain identified in hypertrophic cardiomyopathy subjects with preserved left ventricular ejection fraction using a novel multi-layer transthoracic echocardiography technique

Ozawa, Koya; Funabashi, Nobusada; Takaoka, Hiroyuki; Kamata, Tomoko; Kanaeda, Akiyo; Saito, Mariko; Nomura, Fumio; Kobayashi, Yoshio

doi:10.1016/j.ijcard.2015.01.070

Cited by 53 publications

(45 citation statements)

References 14 publications

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“…Similar findings were confirmed by STE, tissue Doppler imaging (TDI), phase-contrast magnetic resonance (PC-MR), and strain-encoded (SENC) CMR121325. Most studies carried out transmural analyses by dividing the myocardial wall into two layers (endocardial and epicardial)10262728. Recently invented multiple-layer STE can be used to analyze strain in three myocardial layers, which could reflect layer-specific strains in accordance with anatomic myocardial fiber layers (endo/mid/epiwall)12.…”

Section: Discussionmentioning

confidence: 63%

Distribution pattern of left-ventricular myocardial strain analyzed by a cine MRI based deformation registration algorithm in healthy Chinese volunteers

Liu

Yang

Wan

et al. 2017

Sci Rep

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The cine magnetic resonance imaging based technique feature tracking-cardiac magnetic resonance (FT-CMR) is emerging as a novel, simple and robust method to evaluate myocardial strain. We investigated the distribution characteristics of left-ventricular myocardial strain using a novel cine MRI based deformation registration algorithm (DRA) in a cohort of healthy Chinese subjects. A total of 130 healthy Chinese subjects were enrolled. Three components of orthogonal strain (radial, circumferential, longitudinal) of the left ventricle were analyzed using DRA on steady-state free precession cine sequence images. A distinct transmural circumferential strain gradient was observed in the left ventricle that showed universal increment from the epicardial to endocardial myocardial wall (epiwall: −15.4 ± 1.9%; midwall: −18.8 ± 2.0%; endowall: −22.3 ± 2.3%, P < 0.001). Longitudinal strain showed a similar trend from epicardial to endocardial layers (epiwall: −16.0 ± 2.9%; midwall: −15.6 ± 2.7%; endowall: −14.8 ± 2.4%, P < 0.001), but radial strain had a very heterogeneous distribution and variation. In the longitudinal direction from the base to the apex of the left ventricle, there was a trend of decreasing peak systolic longitudinal strain (basal: −23.3 ± 4.6%; mid: −13.7 ± 7.3%; apical: −13.2 ± 5.5%; P < 0.001). In conclusion, there are distinct distribution patterns of circumferential and longitudinal strain within the left ventricle in healthy Chinese subjects. These distribution patterns of strain may provide unique profiles for further study in different types of myocardial disease.

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Section: Discussionmentioning

confidence: 63%

Distribution pattern of left-ventricular myocardial strain analyzed by a cine MRI based deformation registration algorithm in healthy Chinese volunteers

Liu

Yang

Wan

et al. 2017

Sci Rep

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“…We have already reported the utilities of these novel layer-specific strain measurements. [10][11][12][13][14][15] The spatial resolution of TTE is superior to that of MRI, therefore, if accurate diagnosis of the presence of layer-specific LV myocardial fibrosis is confirmed by T1 weighted cardiac MRI, we speculate that the regional layer-specific peak strain values measured on TTE would be reduced in the corresponding layer-specific lesions with myocardial fibrosis using MRI. Therefore, in this study, we determined the detailed relationship between regional layer-specific peak strain (both PLS and PCS) in LV myocardium and the presence of layer-specific LV myocardial fibrosis confirmed by T1 weighted cardiac MRI in HCM patients.…”

Section: Layer-specific Fibrosis and Strain Tte In Hcmmentioning

confidence: 93%

“…Utility of a multi-layer strain technique on 2D speckle tracking TTE: Using a multi-layer strain technique on 2D speckle tracking TTE, we previously evaluated compensatory mechanisms in HCM patients with preserved LV ejection fraction. 14) In that study, we advocated a new myocardial characteristic indicator; this was the myocardial percentage endocardial strain dependency, as represented by 2D LV GLS and GCS. In such patients, we LAYER-SPECIFIC FIBROSIS AND STRAIN TTE IN HCM Figure 11.…”

Section: Layer-specific Fibrosis and Strain Tte In Hcmmentioning

confidence: 99%

“…However, we have previously evaluated inter-and intraobserver consistency in LV myocardial strain measurements using a novel multi-layer technique in patients with severe aortic stenosis and preserved LV ejection fraction. 15) Furthermore, we also evaluated inter-and intra-observer correlation coefficients for a proportion of endocardial GLS and GCS dependency estimates which were defined as the ratio of endocardial strain to epicardial strain in HCM patients with preserved LV ejection fraction 14) and we generated reliable results. The population in this report was comprised of patients with severe aortic stenosis but the measurement of layer-specific strain on TTE was automatically performed using TTE machines and if sufficient image data are acquired, inter-and intra-observer consistency would be less dependent on the different types of disease, and furthermore, both severe aortic stenosis and HCM have thickened LV walls.…”

Section: Layer-specific Fibrosis and Strain Tte In Hcmmentioning

confidence: 99%

“…9) Furthermore, a recently developed multi-layer speckle tracking TTE technique has enabled the analysis of LV endocardium, epicardium, and whole layer myocardium strain separately. [10][11][12][13][14][15] We speculated that using speckle tracking TTE for regional layer-specific peak longitudinal (PLS) and peak circumferential (PCS) strain in LV myocardium, we could localize and quantify layer-specific LV myocardial fibrosis confirmed by T1 weighted cardiac MRI in HCM patients.…”

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confidence: 99%

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Quantitative Differentiation of LV Myocardium with and without Layer-Specific Fibrosis Using MRI in Hypertrophic Cardiomyopathy and Layer-Specific Strain TTE Analysis

et al. 2018

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SummaryTo achieve further risk stratification in hypertrophic cardiomyopathy (HCM) patients, we localized and quantified layer-specific LVM fibrosis on MRI in HCM patients using regional layer-specific peak longitudinal strain (PLS) and peak circumferential strain (PCS) in LV myocardium (LVM) on speckle tracking transthoracic echocardiography (TTE). A total of 18 HCM patients (14 males; 58 ± 17 years) underwent 1.5T-MRI and TTE. PLS and PCS in each layer of the LVM (endocardium, epicardium, and whole-layer myocardium) were calculated for 17 AHA-defined lesions. MRI assessment showed that fibrosis was classified as endocardial, epicardial, or whole-layer (= either or both of these). Regional PLS was smaller in fibrotic endocardial lesions than in non-fibrotic endocardial lesions (P = 0.004). To detect LV endocardial lesions with fibrosis, ROC curves of regional PLS revealed an area under the curve (AUC) of 0.609 and a best cut-off point of 13.5%, with sensitivity of 65.3% and specificity of 54.3%. Regional PLS was also smaller in fibrotic epicardial lesions than in nonfibrotic epicardial lesions (P < 0.001). To detect LV epicardial lesions with fibrosis, ROC curves of PLS revealed an AUC of 0.684 and a best cut-off point of 9.5%, with sensitivity of 73.5% and specificity of 55.5%. Using whole-layer myocardium analysis, PLS was smaller in fibrotic lesions than in non-fibrotic lesions (P < 0.001). To detect whole-layer LV lesions with fibrosis, ROC curves of regional PLS revealed an AUC of 0.674 and a best cut-off point of 12.5%, with sensitivity of 79.0% and specificity of 50.7%. There were no significant differences in PCS of LV myocardium (endocardium, epicardium, and whole-layer) between fibrotic and nonfibrotic lesions. Quantitative regional PLS but not PCS in LV endocardium, epicardium, and whole-layer myocardium provides useful non-invasive information for layer-specific localization of fibrosis in HCM patients.(Int Heart J 2018; 59: 523-530) Key words: Left ventricular myocardium, Layer-specific peak longitudinal strain, Speckle tracking transthoracic echocardiography, Magnetic resonance imaging R isk stratification for major adverse cardiac events (MACE) including sudden death is important for the management of patients with hypertrophic cardiomyopathy (HCM) because it has been established that implantable cardioverter defibrillators for preventing sudden cardiac death are effective. 1)Occurrence of non-sustained ventricular tachycardia (VT)2) and detection of late enhancement (LE) in left ventricular (LV) myocardium suggesting the presence of myocardial fibrosis, by T1 weighted cardiac magnetic resonance imaging (MRI), 3,4) are very useful predictors for MACE in HCM patients as well as non-dilated LV size and mitral regurgitation 5) and dilated phase HCM. 6) Furthermore, the genetic variation in the SCN10A gene might be associated with cardiac conduction abnormalities in HCM patients.7) However, current stratification algorithms remain incomplete and novel non-invasive strategies are needed in order to ef...

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Early marker of regional left ventricular deformation in patients with hypertrophic cardiomyopathy evaluated by MRI tissue tracking: The effects of myocardial hypertrophy and fibrosis

Chen

Yang

et al. 2017

Magnetic Resonance Imaging

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Characteristic myocardial strain identified in hypertrophic cardiomyopathy subjects with preserved left ventricular ejection fraction using a novel multi-layer transthoracic echocardiography technique

Cited by 53 publications

References 14 publications

Distribution pattern of left-ventricular myocardial strain analyzed by a cine MRI based deformation registration algorithm in healthy Chinese volunteers

Distribution pattern of left-ventricular myocardial strain analyzed by a cine MRI based deformation registration algorithm in healthy Chinese volunteers

Quantitative Differentiation of LV Myocardium with and without Layer-Specific Fibrosis Using MRI in Hypertrophic Cardiomyopathy and Layer-Specific Strain TTE Analysis

Early marker of regional left ventricular deformation in patients with hypertrophic cardiomyopathy evaluated by MRI tissue tracking: The effects of myocardial hypertrophy and fibrosis

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