Evaluation of ventricular hypertrophy: what novel and advanced echocardiographic techniques can add to clinical practice, and racial differences in disease expression and management

Abstract

Risk stratification in patients with left ventricular hypertrophy such as hypertrophic cardiomyopathy (HCM) and cardiac amyloidosis can be challenging, and early detection is an important determinant in patient management. We investigated the role of novel echocardiographic parameters using tissue Doppler imaging and speckle tracking methods to characterize them. PA-TDI (P-wave to A'-wave derived from tissue Doppler imaging) measures the total conduction time, reflecting morphological and electrical remodelling in the left atrium. HCM patients with prolonged PA-TDI were at higher risk for atrial fibrillation. In patients with cardiac amyloidosis, the incremental prognostic value of right ventricular free wall strain (RV FWS) in addition to TAPSE (tricuspid annular plane systolic excursion) was significant. Using left ventricular global longitudinal strain (GLS) and RV FWS, different patterns of ventricular involvement were identified. The RV involvement irrespective of LV systolic function was associated with poor prognosis making it an attractive marker to improve risk stratification.

Racial differences were known to contribute to clinical presentation, management, and outcome of patients with HCM. We found a higher proportion of diabetes and septal hypertrophy in Europeans, whereas hypertension and coronary artery disease were more prevalent amongst Asians. Survival and heart failure hospitalization rates were lower in Asians.