title: Myocardial fibrosis is associated with biventricular dysfunction in patients with hypertrophic cardiomyopathy.
abstract: OBJECTIVE
  To assess left (LV) and right ventricular (RV) function by two-dimensional (2D) speckle tracking echocardiography and its relation to myocardial fibrosis in hypertrophic cardiomyopathy (HCM).
  
  
  METHODS
  We enrolled 50 HCM patients (30 male; 47.3 ± 9.9 years) in our study. Each patient received echocardiography with modern high-end scanners. For speckle tracking analysis of LV and RV function the dedicated software was used. The presence of myocardial fibrosis was detected by cardiac magnetic resonance imaging (MRI).
  
  
  RESULTS
  For intraobserver variability of RV global longitudinal strain, we found a correlation of r = 0.89 (p < 0.001) with a minor bias of 4.9 ± 2.9%. On cardiac MRI 30 patients (60%) demonstrated late gadolinium-enhancement (LGE) of the LV. Of these patients only 7% showed LGE of the RV. HCM patients with myocardial fibrosis had less global longitudinal LV strain in comparison to patients without myocardial fibrosis (-12.8 ± 2.2 vs -21.1 ± 2.6, P < 0.001), thicker interventricular septums (23.7 ± 4.0 vs 19.2 ± 5.1, P < 0.001), larger left atria (34.9 ± 7.1 vs 23.9 ± 5.1, P < 0.001), and impaired diastolic function (E/A-ratio: 1.02 ± 0.22 vs 1.15 ± 0.18, P < 0.01). Comparable results were found for RV function. LV and RV strain correlated with r = 0.85 (p < 0.001).
  
  
  CONCLUSIONS
  HCM is not only a disease of the LV. LGE in HCM is associated with both LV and RV dysfunction. Although RV LGE occurs only in a minority of patients with HCM and LV fibrosis, speckle tracking echocardiography is feasible for evaluating LV and RV dysfunction in these patients.
authors.affiliation: Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany. Cchrprinz@aol.com
authors.forename: Christian
authors.initials: C
authors.lastname: Prinz
authors.forename: Frank
authors.initials: F
authors.lastname: van Buuren
authors.forename: Lothar
authors.initials: L
authors.lastname: Faber
authors.forename: Thomas
authors.initials: T
authors.lastname: Bitter
authors.forename: Nikola
authors.initials: N
authors.lastname: Bogunovic
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Burchert
authors.forename: Dieter
authors.initials: D
authors.lastname: Horstkotte
mesh_terms: D002312:Cardiomyopathy, Hypertrophic / Q000150:complications* / Q000000981:diagnostic imaging*; D004452:Echocardiography / Q000379:methods; D054459:Elasticity Imaging Techniques / Q000379:methods*; D004719:Endomyocardial Fibrosis / Q000150:complications* / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018754:Ventricular Dysfunction / Q000150:complications* / Q000000981:diagnostic imaging*