Presence of Apical Aneurysm and Its Impact on Left Ventricular Mechanics and Mechano‐Energetic Coupling in Patients With Apical Hypertrophic Cardiomyopathy
Year: 2024
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Left ventricular (LV) apical aneurysms (ApAn+) occur in 10%-15% of apical hypertrophic cardiomyopathy (ApHCM) patients and confer considerable morbidity. We hypothesized that ApAn+ adversely impact ventricular mechanics and mechano-energetic coupling in ApHCM. METHODS: Ninety-eight ApHCM patients were identified, of which nine (9%) had ApAn+ and were compared with 89 (91%) who did not (ApAn-). 2D speckle-tracking echocardiography assessed ventricular mechanics using LV global longitudinal strain (GLS) and torsion, and mechano-energetic coupling as myocardial work indices. Clinical events over follow-up were adjudicated. RESULTS: Mean age was 64 ± 15 years, 46% were female, and 3% had an HCM family history, with similar clinical risk factors between groups. Of the nine ApAn+ patients, there were six small (<2 cm) and three moderate-sized (2-4 cm) aneurysms. There was no difference in LV ejection fraction (65 ± 15 vs. 67 ± 11%, p = 0.51) or GLS (-9.6 ± 3.3 vs. -11.9 ± 3.9%, p = 0.09) between ApAn+ versus ApAn-. ApAn+ patients had greater myocardial global wasted work (347 ± 112 vs. 221 ± 165 mmHg%, p = 0.03) and lower global work efficiency (GWE, 75 ± 5 vs. 82 ± 8%, p = 0.006). LV GLS (β = -0.67, p < 0.001), ApAn+ (β = -0.15, p = 0.04), and twist rate (β = -0.14, p = 0.04) were independently associated with GWE. At 3.9-year follow-up, cardiovascular mortality (4%) and heart failure hospitalization (14%) events were similar between groups. CONCLUSION: ApHCM patients with ApAn+ are characterized by more impaired LV mechano-energetic coupling when compared with ApAn-. ApAn+ is independently associated with worse GWE.
Source: Echocardiography
DOI: 10.1111/echo.15938
Institution: Columbia University Irving Medical Center
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4403781839