Left ventricular strain and untwist in hypertrophic cardiomyopathy

relation to exercise capacity

Khalid Abozguia, Ganesh Nallur-Shivu, Thanh T. Phan, Ibrar Ahmed, Rajat Kalra, Rebekah A. Weaver, William J. McKenna, John E. Sanderson, Perry Elliott, Michael Frenneaux

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Background Nonobstructive hypertrophic cardiomyopathy (nHCM) is often associated with reduced exercise capacity despite hyperdynamic systolic function as measured by left ventricular ejection fraction. We sought to examine the importance of left ventricular strain, twist, and untwist as predictors of exercise capacity in nHCM patients.

Methods Fifty-six nHCM patients (31 male and mean age of 52 years) and 43 age-and gender-matched controls were enrolled. We measured peak oxygen consumption (peak VO2) and acquired standard echocardiographic images in all participants. Two-dimensional speckle tracking was applied to measure rotation, twist, untwist rate, strain, and strain rate.

Results The nHCM patients exhibited marked exercise limitation compared with controls (peak VO2 23.28 +/- 6.31 vs 37.70 +/- 7.99 mL/[kg min], P < .0001). Left ventricular ejection fraction in nHCM patients and controls was similar (62.76% +/- 9.05% vs 62.48% +/- 5.82%, P = .86). Longitudinal, radial, and circumferential strain and strain rate were all significantly reduced in nHCM patients compared with controls. There was a significant delay in 25% of untwist in nHCM compared with controls. Both systolic and diastolic apical rotation rates were lower in nHCM patients. Longitudinal systolic and diastolic strain rate correlated significantly with peak VO2 (r = -0.34, P = .01 and r = 0.36, P = .006, respectively). Twenty-five percent untwist correlated significantly with peak VO2 (r = 0.36, P = .006).

Conclusions In nHCM patients, there are widespread abnormalities of both systolic and diastolic function. Reduced strain and delayed untwist contribute significantly to exercise limitation in nHCM patients.

Original languageEnglish
Pages (from-to)825-832
Number of pages8
JournalAmerican Heart Journal
Volume159
Issue number5
Early online date30 Apr 2010
DOIs
Publication statusPublished - May 2010

Keywords

  • speckle tracking echocardiography
  • cardiovascular-disease
  • diastolic dysfunction
  • systolic function
  • heart-failure
  • sudden-death
  • relaxation
  • mechanics
  • abnormalities
  • torsion

Cite this

Abozguia, K., Nallur-Shivu, G., Phan, T. T., Ahmed, I., Kalra, R., Weaver, R. A., ... Frenneaux, M. (2010). Left ventricular strain and untwist in hypertrophic cardiomyopathy: relation to exercise capacity. American Heart Journal, 159(5), 825-832. https://doi.org/10.1016/j.ahj.2010.02.002

Left ventricular strain and untwist in hypertrophic cardiomyopathy : relation to exercise capacity. / Abozguia, Khalid; Nallur-Shivu, Ganesh; Phan, Thanh T.; Ahmed, Ibrar; Kalra, Rajat; Weaver, Rebekah A.; McKenna, William J.; Sanderson, John E.; Elliott, Perry; Frenneaux, Michael.

In: American Heart Journal, Vol. 159, No. 5, 05.2010, p. 825-832.

Research output: Contribution to journalArticle

Abozguia, K, Nallur-Shivu, G, Phan, TT, Ahmed, I, Kalra, R, Weaver, RA, McKenna, WJ, Sanderson, JE, Elliott, P & Frenneaux, M 2010, 'Left ventricular strain and untwist in hypertrophic cardiomyopathy: relation to exercise capacity', American Heart Journal, vol. 159, no. 5, pp. 825-832. https://doi.org/10.1016/j.ahj.2010.02.002
Abozguia, Khalid ; Nallur-Shivu, Ganesh ; Phan, Thanh T. ; Ahmed, Ibrar ; Kalra, Rajat ; Weaver, Rebekah A. ; McKenna, William J. ; Sanderson, John E. ; Elliott, Perry ; Frenneaux, Michael. / Left ventricular strain and untwist in hypertrophic cardiomyopathy : relation to exercise capacity. In: American Heart Journal. 2010 ; Vol. 159, No. 5. pp. 825-832.
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title = "Left ventricular strain and untwist in hypertrophic cardiomyopathy: relation to exercise capacity",
abstract = "Background Nonobstructive hypertrophic cardiomyopathy (nHCM) is often associated with reduced exercise capacity despite hyperdynamic systolic function as measured by left ventricular ejection fraction. We sought to examine the importance of left ventricular strain, twist, and untwist as predictors of exercise capacity in nHCM patients.Methods Fifty-six nHCM patients (31 male and mean age of 52 years) and 43 age-and gender-matched controls were enrolled. We measured peak oxygen consumption (peak VO2) and acquired standard echocardiographic images in all participants. Two-dimensional speckle tracking was applied to measure rotation, twist, untwist rate, strain, and strain rate.Results The nHCM patients exhibited marked exercise limitation compared with controls (peak VO2 23.28 +/- 6.31 vs 37.70 +/- 7.99 mL/[kg min], P < .0001). Left ventricular ejection fraction in nHCM patients and controls was similar (62.76{\%} +/- 9.05{\%} vs 62.48{\%} +/- 5.82{\%}, P = .86). Longitudinal, radial, and circumferential strain and strain rate were all significantly reduced in nHCM patients compared with controls. There was a significant delay in 25{\%} of untwist in nHCM compared with controls. Both systolic and diastolic apical rotation rates were lower in nHCM patients. Longitudinal systolic and diastolic strain rate correlated significantly with peak VO2 (r = -0.34, P = .01 and r = 0.36, P = .006, respectively). Twenty-five percent untwist correlated significantly with peak VO2 (r = 0.36, P = .006).Conclusions In nHCM patients, there are widespread abnormalities of both systolic and diastolic function. Reduced strain and delayed untwist contribute significantly to exercise limitation in nHCM patients.",
keywords = "speckle tracking echocardiography, cardiovascular-disease, diastolic dysfunction, systolic function, heart-failure, sudden-death, relaxation, mechanics, abnormalities, torsion",
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T1 - Left ventricular strain and untwist in hypertrophic cardiomyopathy

T2 - relation to exercise capacity

AU - Abozguia, Khalid

AU - Nallur-Shivu, Ganesh

AU - Phan, Thanh T.

AU - Ahmed, Ibrar

AU - Kalra, Rajat

AU - Weaver, Rebekah A.

AU - McKenna, William J.

AU - Sanderson, John E.

AU - Elliott, Perry

AU - Frenneaux, Michael

PY - 2010/5

Y1 - 2010/5

N2 - Background Nonobstructive hypertrophic cardiomyopathy (nHCM) is often associated with reduced exercise capacity despite hyperdynamic systolic function as measured by left ventricular ejection fraction. We sought to examine the importance of left ventricular strain, twist, and untwist as predictors of exercise capacity in nHCM patients.Methods Fifty-six nHCM patients (31 male and mean age of 52 years) and 43 age-and gender-matched controls were enrolled. We measured peak oxygen consumption (peak VO2) and acquired standard echocardiographic images in all participants. Two-dimensional speckle tracking was applied to measure rotation, twist, untwist rate, strain, and strain rate.Results The nHCM patients exhibited marked exercise limitation compared with controls (peak VO2 23.28 +/- 6.31 vs 37.70 +/- 7.99 mL/[kg min], P < .0001). Left ventricular ejection fraction in nHCM patients and controls was similar (62.76% +/- 9.05% vs 62.48% +/- 5.82%, P = .86). Longitudinal, radial, and circumferential strain and strain rate were all significantly reduced in nHCM patients compared with controls. There was a significant delay in 25% of untwist in nHCM compared with controls. Both systolic and diastolic apical rotation rates were lower in nHCM patients. Longitudinal systolic and diastolic strain rate correlated significantly with peak VO2 (r = -0.34, P = .01 and r = 0.36, P = .006, respectively). Twenty-five percent untwist correlated significantly with peak VO2 (r = 0.36, P = .006).Conclusions In nHCM patients, there are widespread abnormalities of both systolic and diastolic function. Reduced strain and delayed untwist contribute significantly to exercise limitation in nHCM patients.

AB - Background Nonobstructive hypertrophic cardiomyopathy (nHCM) is often associated with reduced exercise capacity despite hyperdynamic systolic function as measured by left ventricular ejection fraction. We sought to examine the importance of left ventricular strain, twist, and untwist as predictors of exercise capacity in nHCM patients.Methods Fifty-six nHCM patients (31 male and mean age of 52 years) and 43 age-and gender-matched controls were enrolled. We measured peak oxygen consumption (peak VO2) and acquired standard echocardiographic images in all participants. Two-dimensional speckle tracking was applied to measure rotation, twist, untwist rate, strain, and strain rate.Results The nHCM patients exhibited marked exercise limitation compared with controls (peak VO2 23.28 +/- 6.31 vs 37.70 +/- 7.99 mL/[kg min], P < .0001). Left ventricular ejection fraction in nHCM patients and controls was similar (62.76% +/- 9.05% vs 62.48% +/- 5.82%, P = .86). Longitudinal, radial, and circumferential strain and strain rate were all significantly reduced in nHCM patients compared with controls. There was a significant delay in 25% of untwist in nHCM compared with controls. Both systolic and diastolic apical rotation rates were lower in nHCM patients. Longitudinal systolic and diastolic strain rate correlated significantly with peak VO2 (r = -0.34, P = .01 and r = 0.36, P = .006, respectively). Twenty-five percent untwist correlated significantly with peak VO2 (r = 0.36, P = .006).Conclusions In nHCM patients, there are widespread abnormalities of both systolic and diastolic function. Reduced strain and delayed untwist contribute significantly to exercise limitation in nHCM patients.

KW - speckle tracking echocardiography

KW - cardiovascular-disease

KW - diastolic dysfunction

KW - systolic function

KW - heart-failure

KW - sudden-death

KW - relaxation

KW - mechanics

KW - abnormalities

KW - torsion

U2 - 10.1016/j.ahj.2010.02.002

DO - 10.1016/j.ahj.2010.02.002

M3 - Article

VL - 159

SP - 825

EP - 832

JO - American Heart Journal

JF - American Heart Journal

SN - 0002-8703

IS - 5

ER -