Risk stratification using myocardial peak longitudinal-strain on speckle-tracking transthoracic-echocardiogram to predict major adverse cardiac events in non ischemic hypertrophic-cardiomyopathy subjects confirmed by MDCT

Funabashi, Nobusada; Takaoka, Hiroyuki; Horie, Sawako; Ozawa, Koya; Takahashi, Maiko; Yajima, Rei; Saito, Mariko; Fujiwara, Keiko; Tani, Akiko; Kamata, Tomoko; Kanaeda, Akiyo; Uehara, Masae; Kataoka, Akihisa; Kobayashi, Yoshio

doi:10.1016/j.ijcard.2013.06.056

Cited by 16 publications

(9 citation statements)

References 7 publications

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“…Two recent studies (24 and 32 patients each) have demonstrated an association between LV‐GLS and nonsustained ventricular tachycardia . In a report of 44 patients, LV‐GLS was found to be attenuated in patients with a major cardiac event . In another study, LV‐GLS was an independent predictor of ICD therapy .…”

Section: Discussionmentioning

confidence: 94%

“…However, the prognostic data on LV‐GLS in HCM are sparse . Two recent studies (24 and 32 patients each) have demonstrated an association between LV‐GLS and nonsustained ventricular tachycardia .…”

Section: Discussionmentioning

confidence: 99%

“…In HCM, LV‐GLS is associated with histopathological changes, in vitro myocardial performance, and myocardial fibrosis . Although it is intuitive to think that LV‐GLS could potentially offer incremental utility in HCM patients, prognostic data regarding the role of LV‐GLS in HCM patients are limited . We sought to study whether LV‐GLS provides incremental prognostic utility for long‐term events in patients with obstructive HCM.…”

Section: Introductionmentioning

confidence: 99%

“…[14][15][16] Although it is intuitive to think that LV-GLS could potentially offer incremental utility in HCM patients, prognostic data regarding the role of LV-GLS in HCM patients are limited. [17][18][19][20][21][22] We sought to study whether LV-GLS provides incremental prognostic utility for long-term events in patients with obstructive HCM.…”

mentioning

confidence: 99%

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Incremental Prognostic Utility of Left Ventricular Global Longitudinal Strain in Hypertrophic Obstructive Cardiomyopathy Patients and Preserved Left Ventricular Ejection Fraction

Tower‐Rader

Popović

Sato

et al. 2017

JAHA

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BackgroundIn obstructive hypertrophic cardiomyopathy patients with preserved left ventricular (LV) ejection fraction, we sought to determine whether LV global longitudinal strain (LV‐GLS) provided incremental prognostic utility.Methods and ResultsWe studied 1019 patients with documented hypertrophic cardiomyopathy (mean age, 50±12 years; 63% men) evaluated at our center between 2001 and 2011. We excluded age <18 years, maximal LV outflow tract gradient <30 mm Hg, bundle branch block or atrial fibrillation, past pacemaker/cardiac surgery, including myectomy/alcohol ablation, and obstructive coronary artery disease. Average resting LV‐GLS was measured offline on 2‐, 3‐, 4‐chamber views using Velocity Vector Imaging (Siemens, Malvern, PA). Outcome was a composite of cardiac death and appropriate internal defibrillator (implantable cardioverter defibrillator) discharge. Maximal LV thickness, LV ejection fraction, indexed left atrial dimension, rest and maximal LV outflow tract gradient, and LV‐GLS were 2.0±0.2 cm, 62±4%, 2.2±4 cm/m2, 52±42 mm Hg, 103±36 mm Hg, and −13.6±4%. During 9.4±3 years of follow‐up, 668 (66%), 166 (16%), and 122 (20%), respectively, had myectomy, atrial fibrillation, and implantable cardioverter defibrillator implantation, whereas 69 (7%) had composite events (62 cardiac deaths). Multivariable competing risk regression analysis revealed that higher age (subhazard ratio, 1.04 [1.02–1.07]), AF during follow‐up (subhazard ratio, 1.39 [1.11–1.69]), and worsening LV‐GLS (subhazard ratio, 1.11 [1.05–1.22]) were associated with worse outcomes, whereas myectomy (subhazard ratio, 0.44 [0.25–0.72]) was associated with improved outcomes (all P<0.01). Sixty‐one percent of events occurred in patients with LV‐GLS worse than median (−13.7%).ConclusionsIn obstructive hypertrophic cardiomyopathy patients with preserved LV ejection fraction, abnormal LV‐GLS was independently associated with higher events, whereas myectomy was associated with improved outcomes.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Incremental Prognostic Utility of Left Ventricular Global Longitudinal Strain in Hypertrophic Obstructive Cardiomyopathy Patients and Preserved Left Ventricular Ejection Fraction

Tower‐Rader

Popović

Sato

et al. 2017

JAHA

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“…Clinical significance, implications, and importance of this study: Until now, myocardial fibrosis on MRI on its own, 3,4) or sole use of whole-layer myocardial strain on TTE, 9,19) have been reported as candidates for predictors of HCM in patients.…”

Section: Layer-specific Fibrosis and Strain Tte In Hcmmentioning

confidence: 93%

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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The prognostic value of standardized reference values for speckle-tracking global longitudinal strain in hypertrophic cardiomyopathy

Hartlage

Kim

Strickland

et al. 2015

Int J Cardiovasc Imaging

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Speckle-tracking left ventricular global longitudinal strain (GLS) assessment may provide substantial prognostic information for hypertrophic cardiomyopathy (HCM) patients. Reference values for GLS have been recently published. We aimed to evaluate the prognostic value of standardized reference values for GLS in HCM patients. An analysis of HCM clinic patients who underwent GLS was performed. GLS was defined as normal (more negative or equal to -16%) and abnormal (less negative than -16%) based on recently published reference values. Patients were followed for a composite of events including heart failure hospitalization, sustained ventricular arrhythmia, and all-cause death. The power of GLS to predict outcomes was assessed relative to traditional clinical and echocardiographic variables present in HCM. 79 HCM patients were followed for a median of 22 months (interquartile range 9-30 months) after imaging. During follow-up, 15 patients (19%) met the primary outcome. Abnormal GLS was the only echocardiographic variable independently predictive of the primary outcome [multivariate Hazard ratio 5.05 (95% confidence interval 1.09-23.4, p = 0.038)]. When combined with traditional clinical variables, abnormal GLS remained independently predictive of the primary outcome [multivariate Hazard ratio 5.31 (95 % confidence interval 1.18-24, p = 0.030)]. In a model including the strongest clinical and echocardiographic predictors of the primary outcome, abnormal GLS demonstrated significant incremental benefit for risk stratification [net reclassification improvement 0.75 (95 % confidence interval 0.21-1.23, p < 0.0001)]. Abnormal GLS is an independent predictor of adverse outcomes in HCM patients. Standardized use of GLS may provide significant incremental value over traditional variables for risk stratification.

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Risk stratification using myocardial peak longitudinal-strain on speckle-tracking transthoracic-echocardiogram to predict major adverse cardiac events in non ischemic hypertrophic-cardiomyopathy subjects confirmed by MDCT

Cited by 16 publications

References 7 publications

Incremental Prognostic Utility of Left Ventricular Global Longitudinal Strain in Hypertrophic Obstructive Cardiomyopathy Patients and Preserved Left Ventricular Ejection Fraction

Incremental Prognostic Utility of Left Ventricular Global Longitudinal Strain in Hypertrophic Obstructive Cardiomyopathy Patients and Preserved Left Ventricular Ejection Fraction

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

The prognostic value of standardized reference values for speckle-tracking global longitudinal strain in hypertrophic cardiomyopathy

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