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Phasic Atrial Function in Hypertrophic Cardiomyopathy: Evaluation Using Strain Rate Imaging
Abstracts
1.82 cm (range 1.4–3.65 cm). Management included beta blocker therapy (73%), implantable cardioverter defibrillator (5%), septal ablation (9%), surgical myomectomy (8%) and permanent pacemaker implantation (13%). 21 (33%) patients died during follow-up, 28% (6/21) of which were non-cardiac caused. Conclusion: The majority of patients identified with HCM are symptomatic and treated with beta blockers. Device therapy, surgery and intervention are infrequently used in the management of HCM in the Waikato.
121 Phasic Atrial Function in Hypertrophic Cardiomyopathy: Evaluation Using Strain Rate Imaging S. Eshoo 1,∗ , C. Semsarian 2 , D. Ross 1 , T. Marwick 3 , L. Thomas 4 1 Westmead
Hospital, University of Sydney, Australia 2 Royal Prince Alfred Hospital, University of Sydney, Australia 3 Princess Alexandra Hospital, University of Queensland, Australia 4 Liverpool Hospital, University of NSW, Australia Objectives: We sought to determine if LA phasic function evaluated by tissue Doppler imaging (TDI) derived strain (SI) and strain rate (SR) would be differentially decreased in patients with hypertrophic cardiomyopathy (HCM) compared to hypertensive and normal subjects. Design: 37 HCM patients were compared to 44 patients with hypertension (HT) and 65 normal controls. Standard echocardiography as well as TDI was performed. Maximal LA volume (Volmax ), minimal LA volume (Volmin ) and LA volume just prior to active atrial contraction (Volp ) were measured and phasic LA volumes were calculated. Global and segmental systolic (S-Sr), early diastolic (E-Sr), late diastolic (A-Sr) strain rate and SI were measured from TDI. Results: Left ventricular mass was increased in both the HCM and HT groups compared to controls but diastolic dysfunction was greater in the HCM group. LA volumes were increased in HCM compared to the HT and normal controls with reductions in S-Sr, E-Sr, A-Sr and SI in the HCM group.
Global S-Sr (s−1 ) Global E-Sr (s−1 ) Global A-Sr (s−1 ) Global SI (%)
2.3 2.3 3.0 36.0
± ± ± ±
0.5 0.7 0.8 7.2
Conclusion: HCM results in LA enlargement with reduced LA phasic function that is reflected in a reduction in S-Sr, E-Sr, A-Sr and SI. Atrial enlargement is likely a consequence of increased diastolic dysfunction in the HCM group, while atrial dysfunction may result from LA enlargement as well as a coexistent atrial myopathy. doi:10.1016/j.hlc.2010.06.788 122 Predictive Value of Left Ventricular Mass and Geometry in Type 2 Diabetes Mellitus for Adverse Cardiovascular Events
doi:10.1016/j.hlc.2010.06.787
Normals (n = 65)
S51
HT (n = 44) 2.3 1.9 3.1 34.1
± ± ± ±
0.6 0.6* 0.7 6.4
HCM (n = 37) 2.0 1.9 2.6 31.9
± ± ± ±
0.6* 0.8* 0.8*,§ 7.4*
Overall P value 0.04 0.004 0.004 0.04
B. Wai 1,2,∗ , S. Patel 1 , M. Ord 2 , S. Grant 1 , P. Srivastava 1,2 , L. Burrell 1,2 1 University
of Melbourne, Department of Medicine, Australia of Cardiology, Austin Health, Australia
2 Department
Background: Diabetes mellitus (T2DM) is associated with left ventricular hypertrophy (LVH) and major adverse cardiovascular events (MACE). The clinical significance of concentric remodeling (CR) in the absence of LVH in T2DM remains controversial. We hypothesized that LVH and CR are common in subjects with T2DM and predict MACE. Methods: We studied 548 consecutive subjects with T2DM attending a complications surveillance program at Austin Health, Australia. LVH was defined as left ventricular mass indexed to height2.7 (LVMH2.7 ) >49 g/m2.7 in males and >45 g/m2.7 in females, and CR as a relative wall thickness >0.42 without LVH. MACE was defined as all cause mortality, stroke, heart failure admission, acute coronary syndrome and peripheral vessel revascularization. Follow-up was censored at first MACE at a mean of 4.9 ± 2.1 years. Cox regression analyses were performed with LVH and CR as independent variables to identify the predictors of MACE. Results: The mean ± SD age of subjects was 61.6.8 ± 12.7 years and 59% were male. During the follow up period, 147 MACE occurred. LVH was present on echocardiography in 56% of subjects, and CR in 17%. Those with LVH and CR were more likely to have MACE (Fig. 1a and b). LVH predicted MACE independent of age, sex, BMI and blood pressure (HR 1.84; CI 1.25–2.70; P 0.002). CR did not independently predict MACE after correcting for the same covariates. Conclusions: LVH is common in T2DM and predicts MACE, further study is needed to assess the clinical benefit of treating LVH beyond blood pressure.
ABSTRACTS
Heart, Lung and Circulation 2010;19S:S1–S268
1.82 cm (range 1.4–3.65 cm). Management included beta blocker therapy (73%), implantable cardioverter defibrillator (5%), septal ablation (9%), surgical myomectomy (8%) and permanent pacemaker implantation (13%). 21 (33%) patients died during follow-up, 28% (6/21) of which were non-cardiac caused. Conclusion: The majority of patients identified with HCM are symptomatic and treated with beta blockers. Device therapy, surgery and intervention are infrequently used in the management of HCM in the Waikato.
121 Phasic Atrial Function in Hypertrophic Cardiomyopathy: Evaluation Using Strain Rate Imaging S. Eshoo 1,∗ , C. Semsarian 2 , D. Ross 1 , T. Marwick 3 , L. Thomas 4 1 Westmead
Hospital, University of Sydney, Australia 2 Royal Prince Alfred Hospital, University of Sydney, Australia 3 Princess Alexandra Hospital, University of Queensland, Australia 4 Liverpool Hospital, University of NSW, Australia Objectives: We sought to determine if LA phasic function evaluated by tissue Doppler imaging (TDI) derived strain (SI) and strain rate (SR) would be differentially decreased in patients with hypertrophic cardiomyopathy (HCM) compared to hypertensive and normal subjects. Design: 37 HCM patients were compared to 44 patients with hypertension (HT) and 65 normal controls. Standard echocardiography as well as TDI was performed. Maximal LA volume (Volmax ), minimal LA volume (Volmin ) and LA volume just prior to active atrial contraction (Volp ) were measured and phasic LA volumes were calculated. Global and segmental systolic (S-Sr), early diastolic (E-Sr), late diastolic (A-Sr) strain rate and SI were measured from TDI. Results: Left ventricular mass was increased in both the HCM and HT groups compared to controls but diastolic dysfunction was greater in the HCM group. LA volumes were increased in HCM compared to the HT and normal controls with reductions in S-Sr, E-Sr, A-Sr and SI in the HCM group.
Global S-Sr (s−1 ) Global E-Sr (s−1 ) Global A-Sr (s−1 ) Global SI (%)
2.3 2.3 3.0 36.0
± ± ± ±
0.5 0.7 0.8 7.2
Conclusion: HCM results in LA enlargement with reduced LA phasic function that is reflected in a reduction in S-Sr, E-Sr, A-Sr and SI. Atrial enlargement is likely a consequence of increased diastolic dysfunction in the HCM group, while atrial dysfunction may result from LA enlargement as well as a coexistent atrial myopathy. doi:10.1016/j.hlc.2010.06.788 122 Predictive Value of Left Ventricular Mass and Geometry in Type 2 Diabetes Mellitus for Adverse Cardiovascular Events
doi:10.1016/j.hlc.2010.06.787
Normals (n = 65)
S51
HT (n = 44) 2.3 1.9 3.1 34.1
± ± ± ±
0.6 0.6* 0.7 6.4
HCM (n = 37) 2.0 1.9 2.6 31.9
± ± ± ±
0.6* 0.8* 0.8*,§ 7.4*
Overall P value 0.04 0.004 0.004 0.04
B. Wai 1,2,∗ , S. Patel 1 , M. Ord 2 , S. Grant 1 , P. Srivastava 1,2 , L. Burrell 1,2 1 University
of Melbourne, Department of Medicine, Australia of Cardiology, Austin Health, Australia
2 Department
Background: Diabetes mellitus (T2DM) is associated with left ventricular hypertrophy (LVH) and major adverse cardiovascular events (MACE). The clinical significance of concentric remodeling (CR) in the absence of LVH in T2DM remains controversial. We hypothesized that LVH and CR are common in subjects with T2DM and predict MACE. Methods: We studied 548 consecutive subjects with T2DM attending a complications surveillance program at Austin Health, Australia. LVH was defined as left ventricular mass indexed to height2.7 (LVMH2.7 ) >49 g/m2.7 in males and >45 g/m2.7 in females, and CR as a relative wall thickness >0.42 without LVH. MACE was defined as all cause mortality, stroke, heart failure admission, acute coronary syndrome and peripheral vessel revascularization. Follow-up was censored at first MACE at a mean of 4.9 ± 2.1 years. Cox regression analyses were performed with LVH and CR as independent variables to identify the predictors of MACE. Results: The mean ± SD age of subjects was 61.6.8 ± 12.7 years and 59% were male. During the follow up period, 147 MACE occurred. LVH was present on echocardiography in 56% of subjects, and CR in 17%. Those with LVH and CR were more likely to have MACE (Fig. 1a and b). LVH predicted MACE independent of age, sex, BMI and blood pressure (HR 1.84; CI 1.25–2.70; P 0.002). CR did not independently predict MACE after correcting for the same covariates. Conclusions: LVH is common in T2DM and predicts MACE, further study is needed to assess the clinical benefit of treating LVH beyond blood pressure.
ABSTRACTS
Heart, Lung and Circulation 2010;19S:S1–S268