Strain analysis during exercise in patients with left ventricular hypertrophy: Impact of etiology

Frédéric Schnell, Erwan Donal, Anne Bernard-Brunet, Amélie Reynaud, Mathew G. Wilson, Christophe Thebault, Carine Ridard, Philippe Mabo, François Carré

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Abstract

Background Hypertrophic cardiomyopathy (HCM) and aortic stenosis (AS) may influence left ventricular (LV) systolic function, despite preservation of LV ejection fraction. The aim of this study was to determine the relative importance of cardiac afterload and myocardial hypertrophy in the potential dysfunction of myocardial deformation, at rest and during standardized exercise. Methods Patients with moderate to severe (≤1.5 cm2) asymptomatic AS and patients with HCM in sinus rhythm were prospectively studied using resting and exercise echocardiography during submaximal exercise. Myocardial deformations were assessed using two-dimensional strain. Exclusion criteria were altered LV ejection fraction (<50%), coronary artery disease, intra-LV obstruction > 30 mm Hg at rest, diastolic LV thickness ≥ 30 mm, and New York Heart Association class > II. Thus, 50 patients (25 with AS, 25 with HCM) were selected and matched for age, sex, rest and exercise blood pressure, degree of LV hypertrophy (defined by maximal wall thickness), and LV ejection fraction. Results Mean resting global longitudinal strain (GLS) was -14.9 ± 4.7% in patients with AS and -16.1 ± 3.9% in those with HCM (P =.30). During exercise (mean heart rate, 110 ± 10 beats/min), mean GLS was -13.9 ± 4.2% in patients with AS and -18.1 ± 5.4% in those with HCM (P =.004). GLS decreased in patients with AS but increased in those with HCM (ΔGLS, 0.9 ± 3.1% and -1.9 ± 3.2%, respectively, P =.003). The same results were observed for global circumferential strain. Mean resting global circumferential strain was -16.4 ± 5.8% in patients with AS and -17.9 ± 4.5% in those with HCM (P =.36). During exercise, mean global circumferential strain was -13.8 ± 4.1% in patients with AS and -18.6 ± 5.3% in those with HCM (P =.011). Afterload was higher, particularly during exercise, in patients with AS than in those with HCM. Conclusions Longitudinal and circumferential LV deformation during exercise was lower in patients with AS compared with those with HCM, despite similar resting characteristics. The greater afterload observed in patients with AS led to reduced contractile reserve.

Original languageEnglish
Pages (from-to)1163-1169
Number of pages7
JournalJournal of the American Society of Echocardiography
Volume26
Issue number10
DOIs
Publication statusPublished - Oct 2013
Externally publishedYes

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    Schnell, F., Donal, E., Bernard-Brunet, A., Reynaud, A., Wilson, M. G., Thebault, C., Ridard, C., Mabo, P., & Carré, F. (2013). Strain analysis during exercise in patients with left ventricular hypertrophy: Impact of etiology. Journal of the American Society of Echocardiography, 26(10), 1163-1169. https://doi.org/10.1016/j.echo.2013.06.002