European Heart Journal Advance Access originally published online on November 1, 2007
European Heart Journal 2007 28(24):3020-3026; doi:10.1093/eurheartj/ehm454
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A new echocardiographic approach for the detection of non-ischaemic fibrosis in hypertrophic myocardium
1 Department of Medicine I/Center of Cardiovascular Medicine, Würzburg, Germany
2 Department of Radiology, University Hospital Würzburg, Würzburg, Germany
3 Department of Cardiology, St. Georges Hospital, London, UK
4 KU Leuven, Leuven, Belgium
Received 18 May 2007; revised 30 August 2007; accepted 13 September 2007; online publish-ahead-of-print 1 November 2007.
* Corresponding author: Medizinische Klinik und Poliklinik I, Herz- und Kreislaufzentrum der Universität Würzburg, Josef-Schneider Str. 2, D 20, 97080 Wuerzburg, Germany. Tel: +49 931 2010; fax: +49 931 20136291. E-mail address: weidemann_f{at}medizin.uni-wuerzburg.de
Aims: Regional myocardial fibrosis detected by magnetic resonance imaging (MRI) using late enhancement (LE) indicates an unfavorable prognosis. We investigated in a prospective study whether regional non-ischaemic fibrosis in hypertrophic myocardium can also be detected by ultrasonic strain-rate imaging based on specific visual features of the myocardial deformation traces.
Methods and results: This diagnostic study aimed to define left ventricular fibrotic segments in 30 patients with hypertrophic cardiomyopathy (n = 10), severe aortic valve stenosis (n = 10), Fabry disease cardiomyopathy (n = 10), and 10 healthy controls. MRI and strain-rate imaging (=deformation imaging) was performed in all patients and controls to detect LE. In total, 42 segments showed LE according to MRI criteria. Using strain-rate imaging, all LE positive segments displayed a characteristic pattern consisting of a first peak in early systole followed by a rapid fall in strain rate close to zero and a second peak during isovolumetric relaxation. This ‘double peak sign’ was never seen in segments of healthy controls. However, it was detected in 10 segments without LE. These ‘false-positive’ segments belonged to Fabry patients who often develop a fast progressing fibrosis. In a follow-up MRI study after 2 years (available for 6/10 segments), all these segments had developed LE.
Conclusion: The ‘double peak sign’ in strain-rate imaging tracings seems to be a reliable tool to diagnose regional fibrosis.
Key Words: Fibrosis • Late enhancement • Strain rate • Myocardial function
The first two authors contributed equally to this work. This paper was guest edited by Prof. Thierry Gillebert, Department of Cardiovascular Medicine, University of Gent, Gent, Belgium
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