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J Am Coll Cardiol, 2006; 47:1175-1181, doi:10.1016/j.jacc.2005.10.061 (Published online 21 February 2006).
© 2006 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: HYPERTROPHIC CARDIOMYOPATHY

Global and Regional Myocardial Function Quantification by Two-Dimensional Strain

Application in Hypertrophic Cardiomyopathy

Karim Serri, MD, Patricia Reant, MD, Marianne Lafitte, MD*, Marianne Berhouet, MD, Valerie Le Bouffos, MD, Raymond Roudaut, MD and Stephane Lafitte, MD, PhD

Cardiologic Hospital, Bordeaux 2 University, Pessac, France

Manuscript received July 4, 2005; revised manuscript received September 16, 2005, accepted October 3, 2005.

* Reprint requests and correspondence: Dr. Stephane Lafitte, Service des Echocardiographies, Hôpital Cardiologique Haut-Leveque, Avenue Magellan, Pessac 33600, France. (Email: stephane.lafitte{at}chu-bordeaux.fr).

OBJECTIVES: Recently, a novel method to measure strain from standard two-dimensional images has been developed. Our goal was to characterize global and regional systolic function abnormalities using this technique in patients with hypertrophic cardiomyopathy (HCM).

BACKGROUND: Strain has been proposed as a sensitive tool to detect early systolic function abnormalities in HCM. However, the clinical application of conventional Doppler-derived strain has been limited by poor reproducibility and angle dependency.

METHODS: Echocardiographic examinations were performed in 26 patients with nonobstructive HCM and 45 healthy subjects. Using a dedicated software package, bidimensional acquisitions were analyzed to measure longitudinal and transverse strain in apical views and circumferential and radial strain in parasternal short-axis view.

RESULTS: Despite apparently normal left ventricular systolic function, all components of strain were significantly reduced in HCM. Average longitudinal, transverse, circumferential, and radial strain in patients with HCM and controls were –15.1 ± 6.2% versus –20.3 ± 5.6%, 23.3 ± 17.0% versus 27.2 ± 14.9%, –16.8 ± 7.1% versus 19.6 ± 5.2%, and 25.2 ± 13.9% versus 36.8 ± 17.2%, respectively (all p < 0.001). In patients with asymmetrical HCM, longitudinal septal strain was significantly lower than for other left ventricular segments combined: –9.2 ± 4.7% versus –12.7 ± 7.1% (p = 0.001). Average interobserver and intraobserver variabilities were 11% and 11.3%, respectively.

CONCLUSIONS: Two-dimensional strain is a new simple, rapid, and reproducible method to measure different components of systolic strain. This technique identified early abnormalities in patients with HCM that have apparently normal left ventricular systolic function.

Abbreviations and Acronyms
  2D = two-dimensional
  HCM = hypertrophic cardiomyopathy
  LV = left ventricular
  MR = mitral regurgitation
  MRI = magnetic resonance imaging
  TDI = tissue Doppler imaging




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