Successful MACE risk stratification in hypertrophic cardiomyopathy patients using different 2D speckle-tracking TTE approaches.

PURPOSE: We performed 2D speckle tracking transthoracic-echocardiography (TTE) to compare the ability to predict occurrence of major adverse cardiac events (MACE) between global longitudinal strain (GLS) and circumferential strain (GCS) in left ventricular (LV) myocardium in hypertrophic cardiomyopathy (HCM) patients without obstructed coronary arteries.

METHODS: We measured 2D LV GLS and GCS retrospectively by TTE within 13months of performance of cardiac CT in 41 consecutive symptomatic HCM patients (27 males; 60±13years) without obstructed coronary arteries on CT. Patients were followed up for a median period of 30months.

RESULTS: MACE occurred in 7 (17%) patients. The Cox proportional hazard model for univariate analysis revealed that 2D LV GLS (hazard ratio (HR) 1.89, P=0.019) was a significant predictor of MACE but GCS (HR 1.07, P=0.118) was not. The Cox model for multivariate analysis revealed that 2D LV GLS (hazard ratio 2.144, P=0.013) was a significant predictor for MACE. In receiver operating characteristic (ROC) curves at a best cut-off of -9.65% (2D LV GLS) and -29.35% (2D LV GCS), the sensitivity and specificity for MACE occurrence were 100% and 64.7% (2D LV GLS) and 100% and 47.1% (2D LV GCS), respectively. Kaplan Meier analysis revealed significant differences in MACE occurrence during the follow-up period between ≦-9.65 and >9.65% of 2D LV GLS (P=0.004) and ≦-29.35 and >-29.35% of 2D LV GCS (P=0.017).

CONCLUSIONS: Both 2D LV GLS and GCS (2D LV GLS>GCS) on TTE can predict poor prognosis in HCM patients without obstructed coronary arteries.