Skip to main content
SpringerLink
Log in

Systolic and diastolic myocardial mechanics in hypertrophic cardiomyopathy and their link to the extent of hypertrophy, replacement fibrosis and interstitial fibrosis

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

Aim of the present study was to investigate the relations between myocardial mechanics and the extent of hypertrophy and fibrosis in hypertrophic cardiomyopathy (HCM). Forty-five consecutive patients with HCM and 15 subjects without structural heart disease were included. Cardiac magnetic resonance with late gadolinium enhancement (LGE) imaging was performed to evaluate biventricular function, LV mass index and presence/extent of LGE, expression of replacement fibrosis. Myocardial T1 relaxation, a surrogate of interstitial fibrosis, was measured from Look-Locker sequence. Feature-tracking analysis was applied to LV basal, mid and apical short-axis images to assess systolic and diastolic global LV circumferential strain (CS) and strain rate (CSr). Peak systolic CS and CSr were significantly higher among HCM patients as compared to control subjects (p = 0.015 and p = 0.007, respectively). The ratio of peak CSr during early filling to peak systolic CSr was significantly lower among HCM patients (p = 0.002). At multivariate linear regression analysis, LV mass index (p < 0.001) and  %LV LGE (p = 0.011) were significantly and independently related to peak systolic CS; LV mass index (p < 0.001) and  %LV LGE (p = 0.023) were significantly and independently related to peak systolic CSr;  %LV LGE (p = 0.021) and T1 ratio (p = 0.006) were significantly and independently related to the ratio of peak CSr during early filling to peak systolic CSr. LV systolic mechanics are enhanced and LV diastolic mechanics are impaired in HCM. Extent of hypertrophy and replacement fibrosis influence the LV systolic mechanics while extent of replacement fibrosis and interstitial fibrosis influence the LV diastolic mechanics.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Gersh BJ, Maron BJ, Bonow RO et al (2011) 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 124:e783–831

    Article  PubMed  Google Scholar 

  2. Elliott PM, Anastasakis A, Borger MA et al (2014) 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the task force for the diagnosis and management of hypertrophic cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J 35:2733–2779

    Article  PubMed  Google Scholar 

  3. Chen X, Zhao T, Lu M et al (2014) The relationship between electrocardiographic changes and CMR features in asymptomatic or mildly symptomatic patients with hypertrophic cardiomyopathy. Int J Cardiovasc Imaging 30(Suppl 1):55–63

    Article  PubMed  Google Scholar 

  4. Ennis DB, Epstein FH, Kellman P et al (2003) Assessment of regional systolic and diastolic dysfunction in familial hypertrophic cardiomyopathy using MR tagging. Magn Reson Med 50:638–642

    Article  PubMed Central  PubMed  Google Scholar 

  5. Serri K, Reant P, Lafitte M et al (2006) Global and regional myocardial function quantification by two-dimensional strain: application in hypertrophic cardiomyopathy. J Am Coll Cardiol 47:1175–1181

    Article  PubMed  Google Scholar 

  6. Carasso S, Yang H, Woo A et al (2008) Systolic myocardial mechanics in hypertrophic cardiomyopathy: novel concepts and implications for clinical status. J Am Soc Echocardiogr 21:675–683

    Article  PubMed  Google Scholar 

  7. Wang J, Buergler JM, Veerasamy K, Ashton YP, Nagueh SF (2009) Delayed untwisting: the mechanistic link between dynamic obstruction and exercise tolerance in patients with hypertrophic obstructive cardiomyopathy. J Am Coll Cardiol 54:1326–1334

    Article  PubMed  Google Scholar 

  8. Carasso S, Yang H, Woo A et al (2010) Diastolic myocardial mechanics in hypertrophic cardiomyopathy. J Am Soc Echocardiogr 23:164–171

    Article  PubMed  Google Scholar 

  9. Yang H, Carasso S, Woo A et al (2010) Hypertrophy pattern and regional myocardial mechanics are related in septal and apical hypertrophic cardiomyopathy. J Am Soc Echocardiogr 23:1081–1089

    Article  PubMed  Google Scholar 

  10. Abozguia K, Nallur-Shivu G, Phan TT et al (2010) Left ventricular strain and untwist in hypertrophic cardiomyopathy: relation to exercise capacity. Am Heart J 159:825–832

    Article  PubMed Central  PubMed  Google Scholar 

  11. Pacileo G, Baldini L, Limongelli G et al (2011) Prolonged left ventricular twist in cardiomyopathies: a potential link between systolic and diastolic dysfunction. Eur J Echocardiogr 12:841–849

    Article  PubMed  Google Scholar 

  12. Soullier C, Obert P, Doucende G et al (2012) Exercise response in hypertrophic cardiomyopathy: blunted left ventricular deformational and twisting reserve with altered systolic-diastolic coupling. Circ Cardiovasc Imaging 5:324–332

    Article  PubMed  Google Scholar 

  13. Urbano-Moral JA, Rowin EJ, Maron MS, Crean A, Pandian NG (2014) Investigation of global and regional myocardial mechanics with 3-dimensional speckle tracking echocardiography and relations to hypertrophy and fibrosis in hypertrophic cardiomyopathy. Circ Cardiovasc Imaging 7:11–19

    Article  PubMed  Google Scholar 

  14. Bogaert J, Olivotto I (2014) MR imaging in hypertrophic cardiomyopathy: from magnet to bedside. Radiology 273:329–348

    Article  PubMed  Google Scholar 

  15. Augustine D, Lewandowski AJ, Lazdam M et al (2013) Global and regional left ventricular myocardial deformation measures by magnetic resonance feature tracking in healthy volunteers: comparison with tagging and relevance of gender. J Cardiovasc Magn Reson 15:8

    Article  PubMed Central  PubMed  Google Scholar 

  16. Nucifora G, Muser D, Morocutti G et al (2014) Disease-specific differences of left ventricular rotational mechanics between cardiac amyloidosis and hypertrophic cardiomyopathy. Am J Physiol Heart Circ Physiol 307:H680–688

    Article  CAS  PubMed  Google Scholar 

  17. Nacif MS, Turkbey EB, Gai N et al (2011) Myocardial T1 mapping with MRI: comparison of Look-Locker and MOLLI sequences. J Magn Reson Imaging 34:1367–1373

    Article  PubMed Central  PubMed  Google Scholar 

  18. Sibley CT, Noureldin RA, Gai N et al (2012) T1 Mapping in cardiomyopathy at cardiac MR: comparison with endomyocardial biopsy. Radiology 265:724–732

    Article  PubMed Central  PubMed  Google Scholar 

  19. Sechtem U, Pflugfelder PW, Gould RG, Cassidy MM, Higgins CB (1987) Measurement of right and left ventricular volumes in healthy individuals with cine MR imaging. Radiology 163:697–702

    Article  CAS  PubMed  Google Scholar 

  20. Kawel N, Turkbey EB, Carr JJ et al (2012) Normal left ventricular myocardial thickness for middle-aged and older subjects with steady-state free precession cardiac magnetic resonance: the multi-ethnic study of atherosclerosis. Circ Cardiovasc Imaging 5:500–508

    Article  PubMed Central  PubMed  Google Scholar 

  21. Lever HM, Karam RF, Currie PJ, Healy BP (1989) Hypertrophic cardiomyopathy in the elderly. Distinctions from the young based on cardiac shape. Circulation 79:580–589

    Article  CAS  PubMed  Google Scholar 

  22. Harrigan CJ, Peters DC, Gibson CM et al (2011) Hypertrophic cardiomyopathy: quantification of late gadolinium enhancement with contrast-enhanced cardiovascular MR imaging. Radiology 258:128–133

    Article  PubMed  Google Scholar 

  23. Iles LM, Ellims AH, Llewellyn H et al (2015) Histological validation of cardiac magnetic resonance analysis of regional and diffuse interstitial myocardial fibrosis. Eur Heart J Cardiovasc Imaging 16:14–22

    Article  PubMed  Google Scholar 

  24. Messroghli DR, Rudolph A, Abdel-Aty H et al (2010) An open-source software tool for the generation of relaxation time maps in magnetic resonance imaging. BMC Med Imaging 10:16

    Article  PubMed Central  PubMed  Google Scholar 

  25. Choi EY, Hwang SH, Yoon YW et al (2013) Correction with blood T1 is essential when measuring post-contrast myocardial T1 value in patients with acute myocardial infarction. J Cardiovasc Magn Reson 15:11

    Article  PubMed Central  PubMed  Google Scholar 

  26. Kobayashi T, Dhillon A, Popovic Z et al (2014) Differences in global and regional left ventricular myocardial mechanics in various morphologic subtypes of patients with obstructive hypertrophic cardiomyopathy referred for ventricular septal myotomy/myectomy. Am J Cardiol 113:1879–1885

    Article  PubMed  Google Scholar 

  27. Partridge JB, Smerup MH, Petersen SE, Niederer PF, Anderson RH (2014) Linking left ventricular function and mural architecture: what does the clinician need to know? Heart 100:1289–1298

    Article  PubMed  Google Scholar 

  28. Motoyasu M, Kurita T, Onishi K et al (2008) Correlation between late gadolinium enhancement and diastolic function in hypertrophic cardiomyopathy assessed by magnetic resonance imaging. Circ J 72:378–383

    Article  PubMed  Google Scholar 

  29. Moreo A, Ambrosio G, De Chiara B et al (2009) Influence of myocardial fibrosis on left ventricular diastolic function: noninvasive assessment by cardiac magnetic resonance and echo. Circ Cardiovasc Imaging 2:437–443

    Article  PubMed Central  PubMed  Google Scholar 

  30. Ellims AH, Iles LM, Ling LH et al (2012) Diffuse myocardial fibrosis in hypertrophic cardiomyopathy can be identified by cardiovascular magnetic resonance, and is associated with left ventricular diastolic dysfunction. J Cardiovasc Magn Reson 14:76

    Article  PubMed Central  PubMed  Google Scholar 

  31. Fang L, Beale A, Ellims AH et al (2013) Associations between fibrocytes and postcontrast myocardial T1 times in hypertrophic cardiomyopathy. J Am Heart Assoc 2:e000270

    Article  PubMed Central  PubMed  Google Scholar 

  32. Gai N, Turkbey EB, Nazarian S et al (2011) T1 mapping of the gadolinium-enhanced myocardium: adjustment for factors affecting interpatient comparison. Magn Reson Med 65:1407–1415

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiology, Cardiothoracic Department, University Hospital “Santa Maria della Misericordia”, Udine, Italy

    Gaetano Nucifora, Daniele Muser, Pasquale Gianfagna, Giorgio Morocutti & Alessandro Proclemer

Authors
  1. Gaetano Nucifora
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniele Muser
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pasquale Gianfagna
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giorgio Morocutti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alessandro Proclemer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gaetano Nucifora.

Ethics declarations

Conflict of interest

No conflicts of interest, financial or otherwise, are declared by the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nucifora, G., Muser, D., Gianfagna, P. et al. Systolic and diastolic myocardial mechanics in hypertrophic cardiomyopathy and their link to the extent of hypertrophy, replacement fibrosis and interstitial fibrosis. Int J Cardiovasc Imaging 31, 1603–1610 (2015). https://doi.org/10.1007/s10554-015-0720-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-015-0720-0

Keywords

Search

Navigation