119 Additive Value of longitudinal myocardial function at rest and during exercise in differentiating physiologic and pathologic left ventricular hypertrophies

BackgroundDespite extensive research on this subject, differentiation of pathologic from physiologic left ventricular (LV) hypertrophy remains challenging.PurposeWe sought to describe LV-myocardial deformations at rest and during exercise in the perspective of differentiating forms of LV remodeling.MethodsThis prospective study included 17 healthy sedentary control subjects and 36 subjects with LV hypertrophy (H): 10 elite athletes (kayakers), 10 patients with primitive hypertrophic cardiomyopathy, six patients with LVH exclusively due to hypertension, and 10 patients with both LVH and asymptomatic severe aortic stenosis. Each patient was investigated according to the same standardized protocol of exercise echocardiography.ResultsThe groups showed similar LV ejection fractions. The resting diastolic and systolic deformation parameters were significantly different in physiologic and pathologic hypertrophy patients, but overlapped between groups. Exercise widened these differences: E/E’, S’, mean longitudinal and radial strains, and mean circumferential strain were significantly different between LVH types. According to ROC-analysis, the (especially septal) exercise longitudinal strain provided a discriminative cut-off depending on the LVH etiology (AUC 0.9; cut-off -18.4 = sensibility 0.80; specificity 0.88).ConclusionThe additive value of echocardiographic deformations during exercise in differentiating physiologic and pathologic LV-hypertrophy is providing clues for difficult diagnosis in routine clinic