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Could two-dimensional radial strain be considered as a novel tool to identify pre-clinical hypertrophic cardiomyopathy mutation carriers?

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Abstract

Treatment of overt form of hypertrophic cardiomyopathy (HCM) is often unsuccessful. Efforts are focused on a possible early identification in order to prevent or delaying the development of hypertrophy. Our aim was to find an echocardiographic marker able to distinguish mutation carriers without left ventricular hypertrophy (LVH) from healthy subjects. We evaluated 28 patients, members of eight families. Three types of mutation were recognized: MYBPC3 (five families), MYH7 (two families) and TNNT2 (one family). According to genetic (G) and phenotypic (Ph) features, patients were divided in three groups: Group A (10 patients), mutation carriers with LVH (G+/Ph+); Group B (9 patients), mutation carriers without LVH (G+/Ph−); Group C (9 patients), healthy subjects (G−/Ph−). Echocardiography examination was performed acquiring standard 2D, DTI and 2D-strain imaging. Global longitudinal strain (GLS) and global radial strain (GRS) at basal and mid-level were measured. GRS was significantly different between group B and C at basal level (32.18% ± 9.6 vs. 44.59% ± 12.67 respectively; p-value < 0.0001). In basal posterior and basal inferior segments this difference was particularly evident. ROC curves showed for both the involved segments good AUCs (0.931 and 0.861 for basal posterior and inferior GRS respectively) with the best predictive cut-off for basal posterior GRS at 43.65%, while it was 38.4% for basal inferior GRS. Conversely, GLS values were similar in the three group. 2D longitudinal strain is a valid technique to study HCM. Radial strain and particularly basal posterior and inferior segmental reduction could be able to identify mutation carriers in a pre-clinical phase of disease.

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Acknowledgements

The Authors would like to thank the patients who participated in this study. Their willingness and their enthusiasm encouraged us throughout our work.

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Authors and Affiliations

  1. Cardiology, Cardiocentes A. De Gasperis Department, ASST GOM Niguarda Ca’ Granda, Piazza ospedale maggiore 3, 20151, Milan, Italy

    Gloria Maria Santambrogio, Alessandro Maloberti, Paola Vallerio, Angelica Peritore, Francesca Spanò, Lucia Occhi, Francesco Musca, Oriana Belli, Benedetta De Chiara, Francesca Casadei, Fabio Turazza, Cristina Giannattasio & Antonella Moreo

  2. School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy

    Alessandro Maloberti, Lucia Occhi, Rita Facchetti & Cristina Giannattasio

  3. Laboratory Medicine, ASST GOM Niguarda Ca’ Granda, Milan, Italy

    Emanuela Manfredini

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  1. Gloria Maria Santambrogio
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Correspondence to Gloria Maria Santambrogio.

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Santambrogio, G.M., Maloberti, A., Vallerio, P. et al. Could two-dimensional radial strain be considered as a novel tool to identify pre-clinical hypertrophic cardiomyopathy mutation carriers?. Int J Cardiovasc Imaging 35, 2167–2175 (2019). https://doi.org/10.1007/s10554-019-01668-9

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