070: Heterogeneity in regional peaks of left ventricular deformation is correlated with exercise capacity in primitive hypertrophic cardiomyopathy

Abstract

Previous studies have described a left ventricular (LV) heterogeneity in regional peaks of deformation in patients with primitive hypertrophic cardiomyopathy (HCM). We studied this heterogeneity in HCM patients with echocardiography both at rest and during exercise in order to evaluate its correlation with exercise capacity. Thirty consecutive HCM patients were evaluated with echocardiography at rest and during exercise on a dedicated table. 2D speckle tracking echocardiography (STE) was used to assess LV deformation heterogeneity according to the standard deviation between systolic peaks of regional longitudinal strains. Age was 55.1±12.7 yrs, maximal wall thickness was 20.3±.4 mm. Maximal load during exercise was 94±41 Watts. LV ejection fraction was preserved both at rest and during exercise (67±8% at rest and 69±8% during exercise). Global longitudinal strain (GLS) was altered (-15.5±4.1% at rest and -15.2±5.9% during exercise). Heterogeneity in regional peaks of deformation was 54.6±27.8 ms at rest and 41.3±23.9 ms during exercise. We noted correlations between maximal load achieved (r=-0.48, p=0.007), exercise GLS (r=0.47, p=0.009) and maximal LV thickness (r=0.48, p=0.007) with the level of LV deformation heterogeneity recorded during exercise. These correlations were lower if we considered LV deformation heterogeneity at rest. The population was then divided in 2 groups according to the level of exercise heterogeneity in regional peaks of deformation (cut-off value of 41 ms, i.e. mean value of the global population). The group with the more marked heterogeneity of LV deformation showed the thicker wall, the lower GLS at exercise and the weaker exercise capacity. This result was independent of the age. In CMH patients exercise echocardiography add information. Indeed heterogeneity in regional peaks of deformation in longitudinal LV is correlated with exercise capacity and importance of myocardial hypertrophy.