title: Distinguishing focal fibrotic lesions and non-fibrotic lesions in hypertrophic cardiomyopathy by assessment of regional myocardial strain using two-dimensional speckle tracking echocardiography: comparison with multislice CT.
abstract: OBJECTIVE
  To distinguish focal fibrotic and non-fibrotic lesions in left-ventricular myocardium (LVM) in hypertrophic-cardiomyopathy (HCM)-subjects, we compared myocardial regional peak-strain values using two-dimensional speckle-tracking transthoracic-echocardiography (TTE) in multislice computed-tomography (CT)-detected fibrotic, non-fibrotic and normal control lesions.
  
  
  METHODS
  Twenty subjects (10 consecutive HCM-subjects (8-males, mean 63.4-years), 10 healthy controls (5-males, mean 51.5-years)) underwent speckle-tracking TTE (iE-33), and analysis of regional peak-longitudinal (LS) and radial-strain (RS), and corresponding strain rates in each of 17 LVM segments (American-Heart-Association classification). In HCM-subjects, fibrotic lesions were identified by early-phase defective enhancement and late-phase abnormal enhancement by CT (Light-Speed-Ultra-16). Regional peak LS and RS at basal, mid and apical levels were measured in MSCT-detected fibrotic and non-fibrotic LVM lesions.
  
  
  RESULTS
  In 10 HCM subjects, 143 lesions (84.1%) yielded good tracking on TTE. Twenty lesions showed fibrotic changes in 5 subjects by CT. Regional peak-LS and RS absolute values were significantly lower in both fibrotic and non-fibrotic lesions in HCM subjects than in controls at basal, mid, apical levels (all P<0.05). While peak-LS (%) absolute values were significantly lower in fibrotic than non-fibrotic lesions at basal, mid and apical levels (all P<0.05), regional peak-RS absolute values were significantly lower only at mid levels. LS was a more sensitive indicator than the corresponding rate, with better reproducibility.
  
  
  CONCLUSIONS
  In HCM, regional peak-LS was significantly lower in fibrotic than non-fibrotic lesions in LVM by CT. Regional peak-LS by speckle-tracking provides useful information noninvasively to distinguish fibrotic from non-fibrotic lesions in LVM in HCM and normal LVM in healthy controls.
authors.affiliation: Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan.
authors.forename: Rei
authors.initials: R
authors.lastname: Yajima
authors.forename: Akihisa
authors.initials: A
authors.lastname: Kataoka
authors.forename: Akiyo
authors.initials: A
authors.lastname: Takahashi
authors.forename: Masae
authors.initials: M
authors.lastname: Uehara
authors.forename: Mariko
authors.initials: M
authors.lastname: Saito
authors.forename: Chiharu
authors.initials: C
authors.lastname: Yamaguchi
authors.forename: Kwangho
authors.initials: K
authors.lastname: Lee
authors.forename: Issei
authors.initials: I
authors.lastname: Komuro
authors.forename: Nobusada
authors.initials: N
authors.lastname: Funabashi
mesh_terms: D000328:Adult; D000368:Aged; D057791:Cardiac Imaging Techniques / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging* / Q000473:pathology; D003937:Diagnosis, Differential; D004452:Echocardiography / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D005355:Fibrosis / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D015588:Observer Variation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D055815:Young Adult