Erschienen in:
11.11.2023 | Original Paper
Assessment of left ventricular global longitudinal strain in patients with hypertrophic cardiomyopathy and coronary artery disease
verfasst von:
Medeona Gjergjindreaj, Esteban Escolar, Konstantinos Papadopoulos, Christos G. Mihos
Erschienen in:
The International Journal of Cardiovascular Imaging
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Ausgabe 2/2024
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Abstract
Impaired left ventricular global longitudinal strain (GLS) and coronary artery disease (CAD) each confer adverse prognosis in hypertrophic cardiomyopathy (HCM). Despite their prevalence, data on GLS in co-existent HCM and CAD is lacking. Ninety-six patients with HCM and CAD were retrospectively identified between 2005 and 2021, and analyzed using 2D speckle-tracking echocardiography. Obstructive and non-obstructive CAD patients were compared, multivariate linear regression tested associations between clinical and echocardiographic variables with GLS, and Receiver Operating Characteristic Curve assessed the utility of GLS to predict all-cause mortality at follow-up. Mean age was 71 ± 12.2 years, 41% had obstructive HCM, 78% had obstructive CAD, and 75% had prior acute coronary syndrome. At 4.8-year follow-up, GLS decreased compared with baseline (− 12.5 ± 4.5 vs. − 14 ± 4.2%, p = 0.007), with basal segments experiencing the greatest impairment. GLS was lower in obstructive versus non-obstructive CAD patients at follow-up, although the magnitude was attenuated (baseline: − 13.2 vs. − 17.1%, p < 0.001; follow-up: − 12 vs. − 14.1%, p = 0.05). Interventricular septal thickness (β = 0.54), apical HCM (β = 0.48), and right ventricular systolic pressure (β = 0.39) were associated with more impaired GLS (all p < 0.001), independent of obstructive CAD (β = 0.09, p = 0.44). There were 9 follow-up deaths, with baseline GLS > − 13.5% being a good predictor of all-cause mortality (AUC 0.78, 95% CI 0.64–0.92, sensitivity 88%, specificity 57%, p = 0.01). Patients with HCM and CAD experience progressive GLS impairment over long-term follow-up, with GLS > − 13.5% appearing to be a threshold for predicting all-cause mortality. Apical HCM phenotype is independently associated with worse GLS.