Abstract P102: Assessment of Physiologic and Pathologic Cardiac Hypertrophy by Two-dimensional Strain and Torsion Analysis
PURPOSE. We sought to determine whether speckle tracking imaging (STI) could distinguish between subjects with athletic LVH and those with pathological LVH, such as occurs in hypertensive heart disease, hypertrophic cardiomyopathy (HCM), or aortic stenosis.
METHODS. A total of 127 participants were studied, comprising competitive athletes (30), hypertensive heart disease (30), HCM (12), aortic stenosis (25), and healthy volunteers (30). Left ventricular mass index, ejection fraction, diastolic wall thickness, wall thickness ratio and diastolic and systolic wall-to-volume ratios were determined. LV longitudinal peak systolic strain (L-å), peak systolic strain rate (SR-S), peak early diastolic strain rate (SR-E), and peak late diastolic strain rate (SR-A) values were measured by STI in the basal, mid and apical segments in apical 4-chamber view. LV radial strain (R-å) in parasternal short-axis view was determined by STI. Averaged LV rotation and rotational velocities from the base and apex were also obtained (EchoPac, General Electric), and used for calculation of LV torsion (LVtor).
RESULTS. Left ventricular (LV) mass indices were similar for all forms of LVH (p>.05), which were higher than those obtained in healthy volunteers (p<.05). Athletes had no significant differences in L-å, SR-E and R-å compared with control subjects (p = .21, .85, and .67, respectively). Patients with pathologic LVH had significantly decreased L-å, SR-E, and R-å (average septum: −15.9 ± 3.4%, 1.71 ± 0.35 s−1, and 24.5 ± 11.6%, respectively) compared with control subjects (−22.4 ± 3.3%, 2.51 ± 0.49 s−1, and 37.6 ± 15.2%, respectively; all p<.0005). LVtor increased significantly in pathologic LVH and in athletes compared to normals (p<.005 and .0001, respectively). In pathologic LVH LVtor increased mainly as a result of reduced basal rotation (−3.6±1.2 vs −6.4±1.5 degrees, p=.03). In athletes the LVtor increase was the result of an increase in both basal and apical rotation (basal rotation, −6.2±1.4 vs −9.1±1.6 degrees, p=.05; apical rotation, 16.9±3.1 vs 26.5±4.2 degrees, p=.08).
CONCLUSIONS. Pathologic LVH has significant strain and SR-E reduction versus controls and a different pattern of LV torsion compared to athletes.