Echocardiographic and Cardiac Magnetic Resonance Imaging-Derived Strains in Relation to Late Gadolinium Enhancement in Hypertrophic Cardiomyopathy

      We compared speckle tracking echocardiography (STE) and feature tracking cardiovascular magnetic resonance (FT-CMR) in patients with hypertrophic cardiomyopathy (HC) with a varying extent of fibrosis as defined by late gadolinium enhancement to look at the level of agreement between methods and their ability to relate those to myocardial fibrosis. At 2 reference centers, 79 patients with HC and 16 volunteers (the control group) underwent STE and CMR with late gadolinium enhancement and FT-CMR. Patients were classified into 3 categories: no detectable, limited, and extensive fibrosis. Global longitudinal strain (GLS) and global radial strain (GRS) were derived using FT-CMR and STE. STE-derived GRS was decreased in all HC categories compared with the control group (p <0.001), whereas FT-CMR GRS was reduced only in patients with HC with fibrosis (p <0.05). Reduced STE-derived GLS was associated with extensive fibrosis (p <0.05) and a value less than −15.2% identified those with extensive fibrosis (sensitivity 79%, specificity 92%, area under the curve 0.863, 95% confidence interval [CI] 0.76 to 0.97, p <0.001). Inter-modality agreement was moderate for STE versus CMR-GLS (overall population intra-class correlation coefficient = 0.615, 95% CI 0.42 to 0.75, p <0.001; patients with HC 0.63, 0.42 to 0.76, p <0.001) and GRS (overall population intra-class correlation coefficient = 0.601, 95% CI 0.397 to 0.735, p <0.001). A low level of agreement for GRS was seen between methods in patients with HC. In conclusion, strain indexes measured using echocardiography and CMR are reduced in patients with HC compared with the control group and correlate well with the burden of myocardial fibrosis. Reduced STE-GLS can identify patients with extensive fibrosis, but whether there is an added value for risk stratification for sudden cardiac death remains to be determined.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Gersh BJ
        • Maron BJ
        • Bonow RO
        • Dearani JA
        • Fifer MA
        • Link MS
        • Naidu SS
        • Nishimura RA
        • Ommen SR
        • Rakowski H
        • Seidman CE
        • Towbin JA
        • Udelson JE
        • Yancy CW
        • American College of Cardiology Foundation/American Heart Association Task Force on Practice, American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons
        2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.
        J Thorac Cardiovasc Surg. 2011; 142: e153-e203
        • Maron MS
        • Rowin EJ
        • Wessler BS
        • Mooney PJ
        • Fatima A
        • Patel P
        • Koethe BC
        • Romashko M
        • Link MS
        • Maron BJ.
        Enhanced American College of Cardiology/American Heart Association strategy for prevention of sudden cardiac death in high-risk patients with hypertrophic cardiomyopathy.
        JAMA Cardiol. 2019; 4: 644-657
        • Funabashi N
        • Takaoka H
        • Ozawa K
        • Uehara M
        • Komuro I
        • Kobayashi Y.
        2D speckle-tracking TTE-based quantitative classification of left ventricular myocardium in patients with hypertrophic cardiomyopathy by the presence or the absence of fibrosis and/or hypertrophy.
        Heart Vessels. 2018; 33: 1046-1051
        • Hinojar R
        • Fernández-Golfín C
        • González-Gómez A
        • Rincón LM
        • Plaza-Martin M
        • Casas E
        • García-Martín A
        • Fernandez-Mendez MA
        • Esteban A
        • Nacher JJJ
        • Zamorano JL
        Prognostic implications of global myocardial mechanics in hypertrophic cardiomyopathy by cardiovascular magnetic resonance feature tracking. Relations to left ventricular hypertrophy and fibrosis.
        Int J Cardiol. 2017; 249: 467-472
        • Haland TF
        • Almaas VM
        • Hasselberg NE
        • Saberniak J
        • Leren IS
        • Hopp E
        • Edvardsen T
        • Haugaa KH.
        Strain echocardiography is related to fibrosis and ventricular arrhythmias in hypertrophic cardiomyopathy.
        Eur Heart J Cardiovasc Imaging. 2016; 17: 613-621
        • Urbano-Moral JA
        • Rowin EJ
        • Maron MS
        • Crean A
        • Pandian NG.
        Investigation of global and regional myocardial mechanics with 3-dimensional speckle tracking echocardiography and relations to hypertrophy and fibrosis in hypertrophic cardiomyopathy.
        Circ Cardiovasc Imaging. 2014; 7: 11-19
        • Pagourelias ED
        • Mirea O
        • Vovas G
        • Duchenne J
        • Michalski B
        • Van Cleemput J
        • Bogaert J
        • Vassilikos VP
        • Voigt JU.
        Relation of regional myocardial structure and function in hypertrophic cardiomyopathy and amyloidois: a combined two-dimensional speckle tracking and cardiovascular magnetic resonance analysis.
        Eur Heart J Cardiovasc Imaging. 2019; 20: 426-437
        • Captur G
        • Lobascio I
        • Ye Y
        • Culotta V
        • Boubertakh R
        • Xue H
        • Kellman P
        • Moon JC.
        Motion-corrected free-breathing LGE delivers high quality imaging and reduces scan time by half: an independent validation study.
        Int J Cardiovasc Imaging. 2019; 35: 1893-1901
        • de Marvao A
        • Dawes T
        • Keenan NG
        • Bai W
        • Shi W
        • Durighel G
        • Diamond T
        • Monje-Garcia L
        • Cook SA
        • O'Regan DP
        The UK GenScan study - population-based imaging genetics research using 3D Cardiac Magnetic Resonance.
        J Cardiovasc Magn Reson. 2013; 15: E2
        • Popović ZB
        • Kwon DH
        • Mishra M
        • Buakhamsri A
        • Greenberg NL
        • Thamilarasan M
        • Flamm SD
        • Thomas JD
        • Lever HM
        • Desai MY.
        Association between regional ventricular function and myocardial fibrosis in hypertrophic cardiomyopathy assessed by speckle tracking echocardiography and delayed hyperenhancement magnetic resonance imaging.
        J Am Soc Echocardiogr. 2008; 21: 1299-1305
        • Bogarapu S
        • Puchalski MD
        • Everitt MD
        • Williams RV
        • Weng HY
        • Menon SC.
        Novel cardiac magnetic resonance feature tracking (CMR-FT) analysis for detection of myocardial fibrosis in pediatric hypertrophic cardiomyopathy.
        Pediatr Cardiol. 2016; 37: 663-673
        • Chang SA
        • Lee SC
        • Choe YH
        • Hahn HJ
        • Jang SY
        • Park SJ
        • Choi JO
        • Park SW
        • Oh JK.
        Effects of hypertrophy and fibrosis on regional and global functional heterogeneity in hypertrophic cardiomyopathy.
        Int J Cardiovasc Imaging. 2012; 28: 133-140
        • Saito M
        • Okayama H
        • Yoshii T
        • Higashi H
        • Morioka H
        • Hiasa G
        • Sumimoto T
        • Inaba S
        • Nishimura K
        • Inoue K
        • Ogimoto A
        • Shigematsu Y
        • Hamada M
        • Higaki J.
        Clinical significance of global two-dimensional strain as a surrogate parameter of myocardial fibrosis and cardiac events in patients with hypertrophic cardiomyopathy.
        Eur Heart J Cardiovasc Imaging. 2012; 13: 617-623
        • Tower-Rader A
        • Mohananey D
        • To A
        • Lever HM
        • Popovic ZB
        • Desai MY.
        Prognostic value of global longitudinal strain in hypertrophic cardiomyopathy: A systematic review of existing literature.
        JACC Cardiovasc Imaging. 2019; 12: 1930-1942
        • Liu H
        • Pozios I
        • Haileselassie B
        • Nowbar A
        • Sorensen LL
        • Phillip S
        • Lu DY
        • Ventoulis I
        • Luo H
        • Abraham MR
        • Abraham TP.
        Role of global longitudinal strain in predicting outcomes in hypertrophic cardiomyopathy.
        Am J Cardiol. 2017; 120: 670-675
        • Reant P
        • Reynaud A
        • Pillois X
        • Dijos M
        • Arsac F
        • Touche C
        • Landelle M
        • Rooryck C
        • Roudaut R
        • Lafitte S.
        Comparison of resting and exercise echocardiographic parameters as indicators of outcomes in hypertrophic cardiomyopathy.
        J Am Soc Echocardiogr. 2015; 28: 194-203
        • Obokata M
        • Nagata Y
        • Wu VC
        • Kado Y
        • Kurabayashi M
        • Otsuji Y
        • Takeuchi M.
        Direct comparison of cardiac magnetic resonance feature tracking and 2D/3D echocardiography speckle tracking for evaluation of global left ventricular strain.
        Eur Heart J Cardiovasc Imaging. 2016; 17: 525-532
        • Orwat S
        • Kempny A
        • Diller GP
        • Bauerschmitz P
        • ACh Bunck
        • Maintz D
        • Radke RM
        • Baumgartner H.
        Cardiac magnetic resonance feature tracking: a novel method to assess myocardial strain. Comparison with echocardiographic speckle tracking in healthy volunteers and in patients with left ventricular hypertrophy.
        Kardiol Pol. 2014; 72: 363-371
        • Pryds K
        • Larsen AH
        • Hansen MS
        • Grøndal AYK
        • Tougaard RS
        • Hansson NH
        • Clemmensen TS
        • Løgstrup BB
        • Wiggers H
        • Kim WY
        • Bøtker HE
        • Nielsen RR.
        Myocardial strain assessed by feature tracking cardiac magnetic resonance in patients with a variety of cardiovascular diseases - A comparison with echocardiography.
        Sci Rep. 2019; 9: 11296
        • Candan O
        • Gecmen C
        • Bayam E
        • Guner A
        • Celik M
        • Doğan C.
        Mechanical dispersion and global longitudinal strain by speckle tracking echocardiography: predictors of appropriate implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy.
        Echocardiography. 2017; 34: 835-842
        • Reant P
        • Mirabel M
        • Lloyd G
        • Peyrou J
        • Lopez Ayala JM
        • Dickie S
        • Bulluck H
        • Captur G
        • Rosmini S
        • Guttmann O
        • Demetrescu C
        • Pantazis A
        • Tome-Esteban M
        • Moon JC
        • Lafitte S
        • McKenna WJ
        Global longitudinal strain is associated with heart failure outcomes in hypertrophic cardiomyopathy.
        Heart. 2016; 102: 741-747
        • Hiemstra YL
        • Debonnaire P
        • Bootsma M
        • van Zwet EW
        • Delgado V
        • Schalij MJ
        • Atsma DE
        • Bax JJ
        • Marsan NA.
        Global longitudinal strain and left atrial volume index provide incremental prognostic value in patients with hypertrophic cardiomyopathy.
        Circ Cardiovasc Imaging. 2017; 10e005706
        • Debonnaire P
        • Thijssen J
        • Leong DP
        • Joyce E
        • Katsanos S
        • Hoogslag GE
        • Schalij MJ
        • Atsma DE
        • Bax JJ
        • Delgado V
        • Marsan NA
        Global longitudinal strain and left atrial volume index improve prediction of appropriate implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy patients.
        Int J Cardiovasc Imaging. 2014; 30: 549-558
        • Vergé MP
        • Cochet H
        • Reynaud A
        • Morlon L
        • Peyrou J
        • Vincent C
        • Rooryck C
        • Ritter P
        • Lafitte S
        • Réant P.
        Characterization of hypertrophic cardiomyopathy according to global, regional, and multi-layer longitudinal strain analysis, and prediction of sudden cardiac death.
        Int J Cardiovasc Imaging. 2018; 34: 1091-1098
        • Gräni C
        • Eichhorn C
        • Bière L
        • Kaneko K
        • Murthy VL
        • Agarwal V
        • Aghayev A
        • Steigner M
        • Blankstein R
        • Jerosch-Herold M
        • Kwong RY.
        Comparison of myocardial fibrosis quantification methods by cardiovascular magnetic resonance imaging for risk stratification of patients with suspected myocarditis.
        J Cardiovasc Magn Reson. 2019; 21: 14
        • Maragiannis D
        • Alvarez PA
        • Ghosn MG
        • Chin K
        • Hinojosa JJ
        • Buergler JM
        • Shah DJ
        • Nagueh SF.
        Left ventricular function in patients with hypertrophic cardiomyopathy and its relation to myocardial fibrosis and exercise tolerance.
        Int J Cardiovasc Imaging. 2018; 34: 121-129