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Assessment of left ventricular twist mechanics by speckle tracking echocardiography reveals association between LV twist and myocardial fibrosis in patients with hypertrophic cardiomyopathy.

Zhang HJ, Wang H, Sun T, Lu MJ, Xu N, Wu WC, Sun X, Wang WG, Lin QW - Int J Cardiovasc Imaging (2014)

Bottom Line: No significant differences were found between baseline characteristics of HCM and control groups (all p > 0.05).Bas-Rotation, AP-Rotation, LV-Twist, LADs, IVST, LAVi, E/Em and LVMI were significantly higher in HCM patients with fibrosis than in those without fibrosis (p < 0.001), but no significant differences in other echocardiographic parameters were found between those with and without fibrosis.Age, Bas-Rotation, AP-Rotation, LV twist, LADs, IVST, LAVi, E/A, E/Em, and LVMI were significant effect factors for fibrosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Ultrasound, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Bei Lishi Road, Xicheng District, Beijing, 100037, People's Republic of China.

ABSTRACT
We aimed to investigate whether left ventricular (LV) twist analysis can detect the extent of myocardial fibrosis in patients with hypertrophic cardiomyopathy (HCM). This prospective case-control study recruited 81 consecutive patients with HCM examined between January 2012 and April 2013. Data of 76 patients were analyzed after excluding 5 patients whose echocardiographic images were of poor quality. Healthy volunteers (n = 46) served as controls. Both groups underwent comprehensive echocardiographic examination (i.e., Bas-Rotation, AP-Rotation, LVEF, LADs, IVST, LAVi, E/Em, LVMI, advanced LV-twist analysis by speckle tracking echocardiography) and magnetic resonance imaging. Between-group differences were analyzed by independent t test; logistic regression analysis was performed to identify effect factors. No significant differences were found between baseline characteristics of HCM and control groups (all p > 0.05). HCM patients had significantly higher Bas-Rotation, AP-Rotation, LV Twist, LVEF, LADs, IVST, LAVi, E/Em and LVMI than controls (all p < 0.0001) and significantly lower LVDd and E/A (both p < 0.001). Bas-Rotation, AP-Rotation, LV-Twist, LADs, IVST, LAVi, E/Em and LVMI were significantly higher in HCM patients with fibrosis than in those without fibrosis (p < 0.001), but no significant differences in other echocardiographic parameters were found between those with and without fibrosis. Age, Bas-Rotation, AP-Rotation, LV twist, LADs, IVST, LAVi, E/A, E/Em, and LVMI were significant effect factors for fibrosis. AUROC analysis showed that LV twist had high discriminatory power to detect extent of myocardial fibrosis (AUC 0.996, 95 % CI 0.989-1.004, p < 0.001). Left ventricular twist mechanics are associated with the extent of myocardial fibrosis. LV-twist assessment by STE may be clinically useful.

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The receiver operating characteristic (ROC) curves for LV-twist, GLS, E/Em and LVEF in HCM patients with and without fibrosis. GLS global 2-dimensional strain
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Fig3: The receiver operating characteristic (ROC) curves for LV-twist, GLS, E/Em and LVEF in HCM patients with and without fibrosis. GLS global 2-dimensional strain

Mentions: Univariate logistic regression revealed that the significant effect factors for fibrosis in HCM patients were age, Bas-Rotation, AP-Rotation, LV-Twist, LADs, IVST, LAVi, E/A, E/Em, LVMI, LVPWT and RWT. When these variables were recruited into multivariate logistic regression, stepwise model selection revealed that LV-twist would be the best factor to detect myocardial fibrosis (Supplemental Table 1). When ROC curve analysis was used to examine the LV-Twist performance in HCM patients with and without myocardial fibrosis, the AUC showed high discriminatory power for LV-twist to distinguish between myocardial fibrosis or no fibrosis (AUC 0.99, 95 % CI 0.99–1.0, p < 0.001, Fig. 3); with an optimal cut-off value of 18.5 for LV-Twist as the lower limit at which to detect patients with fibrosis. Youden index determined sensitivity and specificity to be 98 and 100 %, respectively. The AUC also showed high discriminatory power for GLS and E/Em to distinguish between myocardial fibrosis or no fibrosis (GLS: AUC 1.0, 95 % CI 1.0–1.0, p < 0.001; E/Em: AUC 0.99, 95 % CI 0.99–1.0, p < 0.001) (Fig. 3); with an optimal cut-off value of -14.7 for GLS and 13.4 for E/Em as the lower limit at which to detect patients with fibrosis. Youden index determined sensitivity and specificity to be 100 and 100 % for GLS, and 98 and 96.3 % for E/Em (Table 4).Fig. 3


Assessment of left ventricular twist mechanics by speckle tracking echocardiography reveals association between LV twist and myocardial fibrosis in patients with hypertrophic cardiomyopathy.

Zhang HJ, Wang H, Sun T, Lu MJ, Xu N, Wu WC, Sun X, Wang WG, Lin QW - Int J Cardiovasc Imaging (2014)

The receiver operating characteristic (ROC) curves for LV-twist, GLS, E/Em and LVEF in HCM patients with and without fibrosis. GLS global 2-dimensional strain
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4232740&req=5

Fig3: The receiver operating characteristic (ROC) curves for LV-twist, GLS, E/Em and LVEF in HCM patients with and without fibrosis. GLS global 2-dimensional strain
Mentions: Univariate logistic regression revealed that the significant effect factors for fibrosis in HCM patients were age, Bas-Rotation, AP-Rotation, LV-Twist, LADs, IVST, LAVi, E/A, E/Em, LVMI, LVPWT and RWT. When these variables were recruited into multivariate logistic regression, stepwise model selection revealed that LV-twist would be the best factor to detect myocardial fibrosis (Supplemental Table 1). When ROC curve analysis was used to examine the LV-Twist performance in HCM patients with and without myocardial fibrosis, the AUC showed high discriminatory power for LV-twist to distinguish between myocardial fibrosis or no fibrosis (AUC 0.99, 95 % CI 0.99–1.0, p < 0.001, Fig. 3); with an optimal cut-off value of 18.5 for LV-Twist as the lower limit at which to detect patients with fibrosis. Youden index determined sensitivity and specificity to be 98 and 100 %, respectively. The AUC also showed high discriminatory power for GLS and E/Em to distinguish between myocardial fibrosis or no fibrosis (GLS: AUC 1.0, 95 % CI 1.0–1.0, p < 0.001; E/Em: AUC 0.99, 95 % CI 0.99–1.0, p < 0.001) (Fig. 3); with an optimal cut-off value of -14.7 for GLS and 13.4 for E/Em as the lower limit at which to detect patients with fibrosis. Youden index determined sensitivity and specificity to be 100 and 100 % for GLS, and 98 and 96.3 % for E/Em (Table 4).Fig. 3

Bottom Line: No significant differences were found between baseline characteristics of HCM and control groups (all p > 0.05).Bas-Rotation, AP-Rotation, LV-Twist, LADs, IVST, LAVi, E/Em and LVMI were significantly higher in HCM patients with fibrosis than in those without fibrosis (p < 0.001), but no significant differences in other echocardiographic parameters were found between those with and without fibrosis.Age, Bas-Rotation, AP-Rotation, LV twist, LADs, IVST, LAVi, E/A, E/Em, and LVMI were significant effect factors for fibrosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Ultrasound, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Bei Lishi Road, Xicheng District, Beijing, 100037, People's Republic of China.

ABSTRACT
We aimed to investigate whether left ventricular (LV) twist analysis can detect the extent of myocardial fibrosis in patients with hypertrophic cardiomyopathy (HCM). This prospective case-control study recruited 81 consecutive patients with HCM examined between January 2012 and April 2013. Data of 76 patients were analyzed after excluding 5 patients whose echocardiographic images were of poor quality. Healthy volunteers (n = 46) served as controls. Both groups underwent comprehensive echocardiographic examination (i.e., Bas-Rotation, AP-Rotation, LVEF, LADs, IVST, LAVi, E/Em, LVMI, advanced LV-twist analysis by speckle tracking echocardiography) and magnetic resonance imaging. Between-group differences were analyzed by independent t test; logistic regression analysis was performed to identify effect factors. No significant differences were found between baseline characteristics of HCM and control groups (all p > 0.05). HCM patients had significantly higher Bas-Rotation, AP-Rotation, LV Twist, LVEF, LADs, IVST, LAVi, E/Em and LVMI than controls (all p < 0.0001) and significantly lower LVDd and E/A (both p < 0.001). Bas-Rotation, AP-Rotation, LV-Twist, LADs, IVST, LAVi, E/Em and LVMI were significantly higher in HCM patients with fibrosis than in those without fibrosis (p < 0.001), but no significant differences in other echocardiographic parameters were found between those with and without fibrosis. Age, Bas-Rotation, AP-Rotation, LV twist, LADs, IVST, LAVi, E/A, E/Em, and LVMI were significant effect factors for fibrosis. AUROC analysis showed that LV twist had high discriminatory power to detect extent of myocardial fibrosis (AUC 0.996, 95 % CI 0.989-1.004, p < 0.001). Left ventricular twist mechanics are associated with the extent of myocardial fibrosis. LV-twist assessment by STE may be clinically useful.

Show MeSH
Related in: MedlinePlus