Automated functional imaging for assessment of left ventricular mechanics in the presence of left ventricular hypertrophy.

Background: Increased left ventricular (LV) mass is a well-known independent predictor of cardiovascular morbidity and mortality. Even though these patients have an increased risk of LV diastolic dysfunction; recent data have suggested the presence of subtle LV systolic abnormalities. This study sought to demonstrate if a novel speckle tracking automated functional imaging (AFI) tool would be useful in identifying differences in strain generation between patients with normal and increased LV wall mass.

Methods: Standard measures of LV systolic and diastolic function were collected from 90 patients divided into Group I with LV mass index < 100 g/m(2) and Group II with LV mass index values ≥ 100 g/m(2). AFI was also obtained to measure peak global LV myocardial strain.

Results: As expected, patients with an increased LV mass index had significant LV diastolic abnormalities. However, in addition these patients in Group II not only had significantly lower peak systolic strain values but also significantly lower mitral annular plane systolic excursion (MAPSE) and MA tissue Doppler imaging systolic velocity values than patients in Group I despite having comparable estimates of LV ejection fraction, based on the Simpson's method.

Conclusion: Based on these results, AFI provides prompt point of care information regarding LV function and mechanics and identifies differences in longitudinal strain generation between patients with normal and increased LV wall mass. Additional studies are now required to prospectively determine if AFI measures of LV function might be useful to identify patients with an increased LV mass that will develop symptomatic systolic or diastolic heart failure.