Left ventricular dyssynchrony and 2D and 3D global longitudinal strain for differentiating physiological and pathological left ventricular hypertrophy

Abstract

Background: Diagnosis of hypertrophic cardiomyopathy (HCM) in athletes can be challenging.

Aims: To ascertain parameters that differentiate patients with HCM from athletes with moderate left ventricular (LV) hypertrophy (LVH 13-15mm).

Methods: We retrospectively included 100 men: 50 elite rugby players (25 with moderate LVH and 25 with no LVH), 25 patients with HCM and moderate LVH and 25 controls. LV dyssynchrony was defined as the standard deviation of time to peak 2D longitudinal strain (16-segment model) and global strain components were computed from two- (2D) and three-dimensional (3D) speckle tracking.

Results: 2D global longitudinal strain (GLS) (18±2% vs. 19±2%) and various 3D strain components were similar in athletes with moderate LVH and controls, while LV volumes and dyssynchrony (39±8 vs. 31±9ms; P<0.001) were greater in athletes with moderate LVH. The accuracy for differentiating patients with HCM from athletes ranged between 0.57 and 0.92 for various markers, with the best obtained for LV dyssynchrony (AUC=0.92;>48ms had sensitivity=83%, specificity=89%). Binary logistic regression showed that accuracy was improved when LV dyssynchrony was combined with 2D GLS. HCM was excluded when 2D GLS was preserved (>18%) and there was no LV dyssynchrony (>48ms) and only patients with HCM had reduced longitudinal strain and LV dyssynchrony.

Conclusions: LV dyssynchrony combined with GLS can be used to differentiate athletes with moderate LVH from patients with HCM.

Keywords: Asynchronisme ventriculaire gauche; Athlete's heart; Cœur d’athlète; Hypertrophie ventriculaire gauche; Left ventricular dyssynchrony; Left ventricular hypertrophy; Speckle tracking.