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Microvascular Dysfunction Is Associated With Impaired Myocardial Work in Obstructive and Nonobstructive Hypertrophic Cardiomyopathy: A Multimodality Study

2023-04Journal article Open access
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dc.contributor.authorGarcia Brás, P
dc.contributor.authorAguiar Rosa, S
dc.contributor.authorCardoso, I
dc.contributor.authorBranco, L
dc.contributor.authorGalrinho, A
dc.contributor.authorValentim Gonçalves, A
dc.contributor.authorThomas, B
dc.contributor.authorViegas, JM
dc.contributor.authorFiarresga, A
dc.contributor.authorBranco, G
dc.contributor.authorPereira, R
dc.contributor.authorSelas, M
dc.contributor.authorSilva, F
dc.contributor.authorCruz, I
dc.contributor.authorBaquero, L
dc.contributor.authorCruz Ferreira, R
dc.contributor.authorRocha Lopes, L
dc.date.accessioned2023-11-30T15:51:36Z
dc.date.available2023-11-30T15:51:36Z
dc.date.issued2023-04
dc.description.abstractBackground Two-dimensional speckle tracking echocardiography has been shown to correlate with microvascular dysfunction, a hallmark of hypertrophic cardiomyopathy (HCM). We hypothesized that there is an association between myocardial work and left ventricular ischemia, with incremental value to global longitudinal strain, in patients with HCM. Methods and Results We performed a prospective assessment of patients with HCM, undergoing 2-dimensional speckle tracking echocardiography and stress perfusion cardiac magnetic resonance. Results were stratified according to obstructive or nonobstructive HCM and the presence of significant replacement fibrosis (late gadolinium enhancement ≥15% of left ventricular mass). Seventy-five patients with HCM (63% men, age 55±15 years) were evaluated, 28% with obstructive HCM (mean gradient 89±60 mm Hg). Perfusion defects were found in 90.7%, involving 22.5±16.9% of left ventricular mass, and 38.7% had late gadolinium enhancement ≥15%. In a multivariable analysis, a lower global work index (r=-0.519, β-estimate -10.822; P=0.001), lower global work efficiency (r=-0.379, β-estimate -0.123; P=0.041), and impaired global constructive work (r=-0.532, β-estimate -13.788; P<0.001) significantly correlated with ischemia. A segmental analysis supported these findings, albeit with lower correlation coefficients. A global work index cutoff ≤1755 mm Hg% was associated with hypoperfusion with a sensitivity of 88% and a specificity of 71%, while the best cutoff for global longitudinal strain (>-15.5%) had a sensitivity of 64% and a specificity of 57%. The association between myocardial work and perfusion defects was significant independently of late gadolinium enhancement ≥15% and obstructive HCM. Conclusions Impaired myocardial work was significantly correlated with the extent of ischemia in cardiac magnetic resonance, independently of the degree of left ventricular hypertrophy or fibrosis, with a higher predictive power than global longitudinal strain.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationJ Am Heart Assoc . 2023 Apr 18;12(8):e028857.pt_PT
dc.identifier.doi10.1161/JAHA.122.028857pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/4753
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherAmerican Heart Associationpt_PT
dc.subjectHSM CARpt_PT
dc.subjectHumanspt_PT
dc.subjectAdultpt_PT
dc.subjectFemalept_PT
dc.subjectAgedpt_PT
dc.subjectCardiomyopathy, Hypertrophic* / complicationspt_PT
dc.subjectContrast Media*pt_PT
dc.subjectFibrosispt_PT
dc.subjectGadoliniumpt_PT
dc.subjectMagnetic Resonance Imaging, Cine / methodspt_PT
dc.subjectMalept_PT
dc.subjectMiddle Agedpt_PT
dc.subjectProspective Studiespt_PT
dc.titleMicrovascular Dysfunction Is Associated With Impaired Myocardial Work in Obstructive and Nonobstructive Hypertrophic Cardiomyopathy: A Multimodality Studypt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.issue8pt_PT
oaire.citation.startPagee028857pt_PT
oaire.citation.titleJournal of the American Heart Associationpt_PT
oaire.citation.volume12pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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