Right Ventricular Remodeling, Its Correlates, and Its Clinical Impact in Hypertrophic Cardiomyopathy

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• 作者：Monica Roşca ; MD^a ; ^b ; Andreea Călin ; MD ; PhD^a ; ^b ; Carmen C. Beladan ; MD ; PhD^a ; ^b ; Roxana Enache ; MD^a ; ^b ; Anca D. Mateescu ; MD^a ; Maria-Magdalena Gurzun ; MD^a ; Paula Varga ; MD^a ; Cristian Băicuş ; MD ; PhD^a ; Ioan M. Coman ; MD ; PhD^a ; ^b ; Ruxandra Jurcuţ ; MD ; PhD^a ; ^b ; Carmen Ginghină ; MD ; PhD^a ; ^b ; Bogdan A. Popescu ; MD ; PhD^a ; ^b ; ^{bogdan.a.popescu@gmail.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Hypertrophic cardiomyopathy ; Right ventricle ; Right ventricle remodeling ; Speckle-tracking echocardiography ; Ventricular arrhythmia
• 刊名：Journal of the American Society of Echocardiography
• 出版年：2015
• 出版时间：November 2015
• 年：2015
• 卷：28
• 期：11
• 页码：1329-1338
• 全文大小：1301 K

文摘

Structural right ventricular (RV) abnormalities are present in a substantial proportion of patients with hypertrophic cardiomyopathy (HCM), but the trigger for RV hypertrophy remains unclear. The aim of this study was to assess the relationship between RV and left ventricular (LV) remodeling and the impact of biventricular involvement on clinical status in this setting.

Methods

Ninety-nine patients with HCM and 30 normal subjects with a similar age and gender distribution were prospectively enrolled. Comprehensive echocardiography was performed in all, including the assessment of LV and RV function by tissue Doppler and speckle-tracking echocardiography. Measurement of RV free wall thickness (RVWT) was performed at end-diastole, in a zoomed subcostal view, focusing on the RV midwall.

Results

Patients with HCM had increased RVWT (6.4 ± 1.9 vs 3.6 ± 0.8 mm, P < .001) and lower values of RV global longitudinal strain (−19.4 ± 4.4% vs −23.8 ± 2.7%, P < .001) compared with control subjects. RVWT was independently related to LV mass and LV global longitudinal strain. Increased RVWT was correlated with New York Heart Association class (r = 0.20, P = .04) and calculated sudden cardiac death risk score (r = 0.52, P < .001) and was independently related to the presence of ventricular arrhythmias (odds ratio, 2.02; 95% CI, 1.28–3.19; P = .002).

Conclusions

In patients with HCM, the presence of RV hypertrophy was associated with increased LV mass and reduced LV longitudinal strain, correlated with increased calculated sudden cardiac death risk score, and independently related to the presence of ventricular arrhythmias. These data suggest more severe disease in patients with biventricular HCM.