Saccheri MC, Cianciulli TF, Morita LA, Méndez RJ, Beck MA, Guerra JE, Cozzarin A, Puente LJ, Balletti LR, Lax JA. Speckle tracking echocardiography to assess regional ventricular function in patients with apical hypertrophic cardiomyopathy. World J Cardiol 2017; 9(4): 363-370 [PMID: 28515855 DOI: 10.4330/wjc.v9.i4.363]
Corresponding Author of This Article
Tomás Francisco Cianciulli, MD, FACC, FASE, Division of Cardiology, Echocardiography Laboratory, Hospital “Dr. Cosme Argerich”, Pi y Margall 750, Ciudad Autónoma de Buenos Aires, Buenos Aires C1155AHD, Argentina. tcianciulli@gmail.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Apr 26, 2017; 9(4): 363-370 Published online Apr 26, 2017. doi: 10.4330/wjc.v9.i4.363
Speckle tracking echocardiography to assess regional ventricular function in patients with apical hypertrophic cardiomyopathy
María Cristina Saccheri, Tomás Francisco Cianciulli, Luis Alberto Morita, Ricardo José Méndez, Martín Alejandro Beck, Juan Enrique Guerra, Alberto Cozzarin, Luciana Jimena Puente, Lorena Romina Balletti, Jorge Alberto Lax
María Cristina Saccheri, Tomás Francisco Cianciulli, Luis Alberto Morita, Ricardo José Méndez, Martín Alejandro Beck, Juan Enrique Guerra, Alberto Cozzarin, Luciana Jimena Puente, Lorena Romina Balletti, Jorge Alberto Lax, Division of Cardiology, Echocardiography Laboratory, Hospital “Dr. Cosme Argerich”, C1155AHD Buenos Aires, Argentina
Tomás Francisco Cianciulli, Researcher of the Ministry of Health, Government of the City of Buenos Aires, Buenos Aires C1155AHD, Argentina
Author contributions: Saccheri MC, Cozzarin A and Puente LJ attended the patient; Cianciulli TF, Beck MA and Lax JA prepared the manuscript and figures; Saccheri MC, Cianciulli TF and Lax JA performed the echocardiographic images and participated in the manuscript description; Morita LA, Méndez RJ, Guerra JE and Balletti LR participated in the design and review of the manuscript; all authors read and approved the final manuscript.
Institutional review board statement: This observational study was exempt from the Institutional Review Boards standards at the Hospital “Dr. Cosme Argerich”.
Informed consent statement: The patient involved in this study gave their written informed consent authorizing use and disclosure of their protected health information.
Conflict-of-interest statement: All the authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tomás Francisco Cianciulli, MD, FACC, FASE, Division of Cardiology, Echocardiography Laboratory, Hospital “Dr. Cosme Argerich”, Pi y Margall 750, Ciudad Autónoma de Buenos Aires, Buenos Aires C1155AHD, Argentina. tcianciulli@gmail.com
Telephone: +54-11-41210879 Fax: +54-11-41210875
Received: September 25, 2016 Peer-review started: September 27, 2016 First decision: October 20, 2016 Revised: December 30, 2016 Accepted: January 14, 2017 Article in press: January 14, 2017 Published online: April 26, 2017 Processing time: 214 Days and 2.7 Hours
Abstract
AIM
To explore regional systolic strain of midwall and endocardial segments using speckle tracking echocardiography in patients with apical hypertrophic cardiomyopathy (HCM).
METHODS
We prospectively assessed 20 patients (mean age 53 ± 16 years, range: 18-81 years, 10 were male), with apical HCM. We measured global longitudinal peak systolic strain (GLPSS) in the midwall and endocardium of the left ventricle.
RESULTS
The diastolic thickness of the 4 apical segments was 16.25 ± 2.75 mm. All patients had a normal global systolic function with a fractional shortening of 50% ± 8%. In spite of supernormal left ventricular (LV) systolic function, midwall GLPSS was decreased in all patients, more in the apical (-7.3% ± -8.8%) than in basal segments (-15.5% ± -6.93%), while endocardial GLPPS was significantly greater and reached normal values (apical: -22.8% ± -7.8%, basal: -17.9% ± -7.5%).
CONCLUSION
This study shows that two-dimensional strain was decreased mainly confined to the mesocardium, while endocardium myocardial deformation was preserved in HCM and allowed to identify subclinical LV dysfunction. This transmural heterogeneity in systolic strain had not been previously described in HCM and could be explained by the distribution of myofibrillar disarray in deep myocardial areas. The clinical application of this novel finding may help further understanding of the pathophysiology of HCM.
Core tip: In this study we prospectively assessed 20 patients with apical hypertrophic cardiomyopathy (HCM) in which we used speckle tracking echocardiography for measuring global longitudinal peak systolic strain in the midwall and endocardium of the left ventricle. We showed that two-dimensional strain was decreased mainly confined to the mesocardium, while endocardial deformation was preserved. This finding allowed to identify subclinical left ventricular systolic dysfunction. This transmural heterogeneity in systolic strain had not been previously described in HCM and could be explained by the distribution of myofibrillar disarray in deep myocardial areas. The clinical application of this novel finding may help further understanding of the pathophysiology of HCM.
