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Evaluation of left atrial and ventricular function in hypertrophic cardiomyopathy using speckle tracking echocardiography

Session Poster session 1

Speaker Rita Ilhao Moreira

Event : EuroEcho 2018

  • Topic : imaging
  • Sub-topic : Tissue Doppler, Speckle Tracking and Strain Imaging
  • Session type : Poster Session

Authors : R Ilhao Moreira (Lisbon,PT), S Aguiar Rosa (Lisbon,PT), L Moura Branco (Lisbon,PT), A Galrinho (Lisbon,PT), J Feliciano (Lisbon,PT), A Fiarresga (Lisbon,PT), AT Timoteo (Lisbon,PT), J Abreu (Lisbon,PT), A Abreu (Lisbon,PT), P Rio (Lisbon,PT), G Portugal (Lisbon,PT), A Monteiro (Lisbon,PT), P Pinto Teixeira (Lisbon,PT), R Cruz Ferreira (Lisbon,PT)

R Ilhao Moreira1 , S Aguiar Rosa1 , L Moura Branco1 , A Galrinho1 , J Feliciano1 , A Fiarresga1 , AT Timoteo1 , J Abreu1 , A Abreu1 , P Rio1 , G Portugal1 , A Monteiro1 , P Pinto Teixeira1 , R Cruz Ferreira1 , 1Hospital de Santa Marta, Cardiology - Lisbon - Portugal ,

European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 1 ), i191

Introduction: Transthoracic Doppler echocardiography (TTE) is the first line imaging method to evaluate hypertrophic cardiomyopathy (HCM) patients (P). The aim is to assess left atrial (LA) and ventricular (LV) strain by TTE in HCM.

Methods: Retrospective analysis of P with normal left ventricular ejection fraction who underwent a comprehensive TTE for HCM evaluation, in a tertiary centre. LA function was assessed by determination of longitudinal strain (LS) and strain rate (SR) in apical 4 chambers view in 3 phases: reservoir, conduit and pump booster. LV global longitudinal strain (GLS) was assessed in apical 4, 2 and 3 chambers view. Radial strain and strain rate was assessed at papillary muscles level in short axis view.

Results: 52 P were enrolled, mean age 66.5±15.9 years, 44% males, 38% with obstructive HCM.

LA SR in conduit and pump booster phases were worse in P with LA dilatation (>40mm) (- -0.43±037 vs -0.88±0.64 s-1, p=0.019 and -0.74±0.62 vs -1.08±0.27 s-1, p=0.037, respectively).

LA LS was substantially different in sinus rhythm and atrial fibrillation P (LS in conduit phase: 8.72±6.56 vs 0.52±2.53%, p=0.006; LS in reservoir phase: 13.29±8.17 vs 6.47±2.72%, p=0.036), as well as SR in reservoir phase (0.63±0.57 vs 0.38±0.25 s-1, p=0.048).

LA strain rate in conduit phase was significantly different in obstructive and non-obstructive HCM (-0.31±0.44 vs -0.65±0.42 s-1, p=0.002) suggesting a more relevant impairment in diastole, particularly in rapid filling phase, in obstructive HCM P.

In overall population, LV GLS was -13.92±6.82%, interventricular septum (IVS) peak longitudinal strain -7.53±6.82% and IVS peak radial strain 22.88±16.64%. There was not a significant difference in these parameters between obstructive and non-obstructive HCM.

There was a concordance between tissue Doppler (septal s’) and IVS peak radial strain. P with septal s’ >6 presented IVS peak radial strain of -12.67±10.67% contrasting with -5.84±5.08% in P with lower s’ (p=0.010).

IVS radial strain rate was higher in P with LA dilatation (2.36±1.13 vs 1.50±0.50 s-1, p=0.029).

P with impairment in LV function assessed by GLS (> -18%) presented lower LA SR in reservoir phase (0.56±0.49 vs 0.93±0.31s-1, p=0.010) and in pump booster phase (-0.70±0.54 vs -8.07±20.6s-1, p=0.016).

Conclusion: Changes in LA strain and strain rate were more evident in the presence of LA dilatation, atrial fibrillation and obstructive HCM. Even with a normal LV ejection fraction, HCM P presented an impairment in GLS, IVS peak longitudinal and radial strain. Lower Tissue Doppler velocity in IVS was associated with worse radial strain in this segment. There was a concordance between the impairment of LA and LV function assessed by strain study.

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