Evaluation of right ventricular function in patients with hypertrophic cardiomyopathy by two-dimensional speckle tracking imaging

doi:10.3877/cma.j.issn.1672-6448.2023.04.007

Abstract

Abstract:

Objective

To evaluate right ventricular function in patients with hypertrophic cardiomyopathy (HCM) by two-dimensional speckle tracking imaging (2D-STI), investigate the influence of left ventricular outflow tract obstruction on right ventricular function in HCM patients, and analyze the correlation between right ventricular function and interventricular septal thickness.

Methods

This was a retrospective observational study in which 60 HCM patients with simple left ventricular wall hypertrophy admitted to Wuhan Asian Heart Hospital from April 2020 to June 2021 were included. The patients were divided into either a hypertrophic non-obstructive cardiomyopathy (HNCM) group (29 patients) or a hypertrophic obstructive cardiomyopathy (HOCM) group (31 patients). Forty healthy volunteers were also included as a control group. Conventional echocardiographic parameters and 2D-STI strain parameters of the three groups were analyzed and compared, and the correlation between right ventricular function and ventricular septal thickness and left ventricular outflow tract pressure in HCM patients was analyzed.

Results

Compared with the control group, the interventricular septal thickness at end diastole, left ventricular posterior wall thickness at end diastole, and left ventricular outflow tract pressure gradient in the HNCM and HOCM groups were increased, while right ventricular fractional area change and tricuspid annular plane systolic excursion were reduced (P＜0.05 for all). The left ventricular outflow tract pressure gradient of the HOCM group was significantly higher that of the HNCM group (P＜0.05). Compared with the control group, right ventricular endocardium, global longitudinal strain, and global radial strain in the HNCM group and HOCM group were decreased. Except the basal radial strain of the right ventricle, right ventricular segmental strain (global longitudinal and radial strain) in the HNCM group and HOCM group was significantly lower than that of the control group (P＜0.05 for all). Compared with the control group, right ventricular segmental global longitudinal strain rate, right ventricular free wall apical radial strain rate, and interventricular septal (basal segment and medium segment) radial strain rate in the HNCM group and HOCM group were decreased (P＜0.05 for all). Strain parameters were not significantly different between the HNCM group and HOCM group (P＞0.05 for all). Right ventricular endocardium, global longitudinal strain, and global radial strain in HCM patients were negatively correlated with interventricular septal thickness (r=-0.655, -0.539, and -0.511, respectively, P＜0.05 for all), but not with the left ventricular outflow tract pressure gradient (r=0.000, 0.162, and 0.016, respectively, P＞0.05 for all).

Conclusion

Right ventricular global and regional functions are impaired in patients with HCM, and right ventricular function is not affected by left ventricular outflow tract obstruction in HCM patients. As new functional indexes, strain and strain rate of 2D-STI technique have good value in the evaluation of right ventricular function in patients with HCM.

Key words: Echocardiography, Two-dimensional speckle tracking imaging, Hypertrophic cardiomyopathy, Right ventricular function

Dandan Chen, Xiaojing Ma, Juan Xia. Evaluation of right ventricular function in patients with hypertrophic cardiomyopathy by two-dimensional speckle tracking imaging[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(04): 417-423.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2023.04.007

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Figures/Tables 6

References 19

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组别	例数	男/女（例）	年龄（岁）	身高（m）	体重（kg）	体表面积（m²）	心率（次/分）	收缩压（mmHg）	舒张压（mmHg）
对照组	40	25/15	53.63±8.92	1.66±0.06	59.98±6.15	1.75±0.11	70.38±8.86	118.65±7.71	72.08±6.99
HNCM组	29	19/10	53.48±7.46	1.66±0.07	61.14±8.25	1.76±0.13	70.69±9.58	117.10±5.91	70.90±8.66
HOCM组	31	22/9	53.48±5.26	1.65±0.06	61.35±6.88	1.75±0.10	69.61±7.97	118.32±8.02	71.29±6.32
统计值		0.562	0.004	0.493	0.402	0.103	0.121	0.394	0.234
P值		0.753	0.996	0.612	0.670	0.902	0.886	0.675	0.791

组别	例数	男/女（例）	年龄（岁）	身高（m）	体重（kg）	体表面积（m²）	心率（次/分）	收缩压（mmHg）	舒张压（mmHg）
对照组	40	25/15	53.63±8.92	1.66±0.06	59.98±6.15	1.75±0.11	70.38±8.86	118.65±7.71	72.08±6.99
HNCM组	29	19/10	53.48±7.46	1.66±0.07	61.14±8.25	1.76±0.13	70.69±9.58	117.10±5.91	70.90±8.66
HOCM组	31	22/9	53.48±5.26	1.65±0.06	61.35±6.88	1.75±0.10	69.61±7.97	118.32±8.02	71.29±6.32
统计值		0.562	0.004	0.493	0.402	0.103	0.121	0.394	0.234
P值		0.753	0.996	0.612	0.670	0.902	0.886	0.675	0.791

参数	例数	IVSD（cm）	LVPWD（cm）	RVEED（cm）	RVFAC（%）	TAPSE（mm）	S'（cm/s）	LVOT-PG（mmHg）
对照组	40	1.04±0.55	0.99±0.47	3.16±0.13	52.31±4.14	21.37±2.09	12.68±0.69	4.44±0.91
HNCM组	29	1.92±0.54^a	1.22±0.23^a	3.16±0.17	47.39±3.36^a	19.78±1.93^a	12.55±0.71	9.07±4.04^a
HOCM组	31	2.10±0.63^a	1.27±0.22^a	3.11±0.15	47.27±3.70^a	19.50±1.75^a	12.49±0.60	63.06±35.34^ab
F值		55.384	25.668	0.836	20.550	9.735	0.800	88.241
P值		＜0.001	＜0.001	0.436	＜0.001	＜0.001	0.452	＜0.001

参数	例数	IVSD（cm）	LVPWD（cm）	RVEED（cm）	RVFAC（%）	TAPSE（mm）	S'（cm/s）	LVOT-PG（mmHg）
对照组	40	1.04±0.55	0.99±0.47	3.16±0.13	52.31±4.14	21.37±2.09	12.68±0.69	4.44±0.91
HNCM组	29	1.92±0.54^a	1.22±0.23^a	3.16±0.17	47.39±3.36^a	19.78±1.93^a	12.55±0.71	9.07±4.04^a
HOCM组	31	2.10±0.63^a	1.27±0.22^a	3.11±0.15	47.27±3.70^a	19.50±1.75^a	12.49±0.60	63.06±35.34^ab
F值		55.384	25.668	0.836	20.550	9.735	0.800	88.241
P值		＜0.001	＜0.001	0.436	＜0.001	＜0.001	0.452	＜0.001

组别	例数	Free-wall basal-LS（%）	Free-wall med-LS （%）	Free-wall apical- LS（%）	Septum basal -LS（%）	Septum med-LS （%）	Septum apical-LS （%）
对照组	40	-32.38±4.46	-26.75±5.11	-21.86±4.69	-21.10±4.79	-19.34±3.65	-21.03±4.65
HNCM组	29	-24.19±3.28^a	-18.07±4.69^a	-12.34±4.86^a	-16.05±3.75^a	-15.24±2.56^a	-15.58±3.01^a
HOCM组	31	-24.14±1.96^a	-15.83±4.63^a	-13.87±4.06^a	-14.61±2.81^a	-14.58±2.89^a	-15.14±2.34^a
F值		65.853	51.034	44.963	26.576	24.374	29.841
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001
组别	例数	Septum basal-RS（%）	Septum med-RS（%）	Septum apical -RS（%）
对照组	40	49.98±13.72	43.22±11.69	48.41±8.69
HNCM组	29	35.43±13.60^a	26.55±8.72^a	44.67±5.96^a
HOCM组	31	33.55±9.15^a	23.35±7.40^a	43.60±4.26^a
F值		18.825	43.739	4.979
P值		＜0.001	＜0.001	0.009
组别	例数	Free-wall basal- RSR（s^-1）	Free-wall med- RSR （s^-1）	Free-wall apical -RSR（s^-1）	Septum basal-RSR（s^-1）	Septum med -RSR （s^-1）	Septum apical -RSR（s^-1）
对照组	40	3.35±1.27	3.24±0.99	2.50±0.98	2.70±0.70	2.28±0.68	1.76±0.44
HNCM组	29	3.51±1.45	2.92±0.62	2.00±0.76^a	2.05±0.68^a	1.65±0.62^a	1.57±0.41
HOCM组	31	3.57±1.56	3.11±0.69	1.94±0.91^a	2.12±0.88^a	1.68±0.71^a	1.55±0.59
F值		0.242	1.278	4.261	8.004	10.192	2.117
P值		0.785	0.283	0.017	0.001	＜0.001	0.126
组别	例数	GLS endo（%）	GLS myo （%）	GRS （%）	Free-wall basal-RS（%）	Free-wall med -RS （%）	Free-wall apical -RS（%）
对照组	40	-22.66±3.96	-18.72±3.00	52.29±14.22	69.33±17.88	66.24±14.37	60.44±13.34
HNCM组	29	-13.42±1.93^a	-12.46±2.06^a	36.60±13.87^a	64.52±9.49	54.82±13.69^a	43.71±7.28^a
HOCM组	31	-12.83±3.53^a	-11.33±2.34^b	36.04±11.54^a	64.36±7.78	56.10±12.24^a	42.39±6.53^a
F值		97.721	87.500	17.070	1.654	7.630	36.498
P值		＜0.001	＜0.001	＜0.001	0.197	＜0.001	＜0.001
组别	例数	Free-wall basal -LSR（s^-1）	Free-wall med -LSR （s^-1）	Free-wall apical LSR（s^-1）	Septum basal-LSR （s^-1）	Septum med -LSR（s^-1）	Septum apical -LSR（s^-1）
对照组	40	-2.02±0.72	-1.73±0.44	-1.44±0.62	-1.21±0.26	-1.11±0.24	-1.33±0.35
HNCM组	29	-1.53±0.83^a	-1.31±0.62^a	-1.15±0.34^a	-0.92±0.32^a	-0.88±0.36^a	-1.03±0.40^a
HOCM组	31	-1.58±0.67^a	-1.36±0.53^a	-1.00±0.36^a	-0.85±0.24^a	-0.75±0.26^a	-1.02±0.30^a
F值		4.593	6.894	7.920	17.170	14.535	8.841
P值		0.012	0.002	0.001	＜0.001	＜0.001	＜0.001

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