Ultrasound Enhancing Agents with Transthoracic Echocardiography for Maximal Wall Thickness in Hypertrophic Cardiomyopathy

Overview

Journal Mayo Clin Proc Innov Qual Outcomes

Specialty Health Services

Date 2023 Jul 28

PMID 37502339

Authors

John P Bois

Chadi Ayoub

Jeffrey B Geske

Yee Weng Wong

Muhannad A Abbasi

Thomas A Foley

Sharon L Mulvagh

Christopher G Scott

Steve R Ommen

Patricia A Pellikka

Affiliations

Soon will be listed here.

Abstract

Objectives: To determine whether ultrasound enhancing agent (UEA) changes maximal wall thickness (WT) in hypertrophic cardiomyopathy (HCM), and if it improves correlation with magnetic resonance imaging (MRI).

Patients And Methods: A total of 107 patients with HCM were prospectively enrolled at a single tertiary referral center between July 10, 2014, and August 31, 2017, and underwent transthoracic echocardiography (TTE) with and without UEA and MRI. Maximal WT measurements were compared, and variability among the 3 modalities was evaluated using a simple linear regression analysis and paired tests and Bland-Altman plots. Interobserver variability for each technique was assessed.

Results: Most (63%) of cardiac imagers found UEA helpful in determining maximal WT by TTE, with 49% reporting change in WT. Of 52 patients where UEA changed WT measurement, 32 (62%) reported an increase and 20 (38%) reported a decrease in WT. The UEA did not alter the median discrepancy in WT between MRI and TTE. However, where UEA increased reported WT, the difference between MRI and TTE improved in 79% of cases (=.001) from 2.0-0.5mm. In those with scar on MRI, UEA improved agreement of WT between TTE and MRI compared with that of TTE without UEA (79% vs 39%; =.011). Interclass correlation coefficient for WT for TTE without UEA, with UEA, and MRI was 0.84; (95% CI, 0.61-0.92), 0.88; (95%CI, 0.82-0.92), and 0.97; (95%CI, 0.96-0.98), respectively.

Conclusion: Although use of UEA did not eliminate differences in WT discrepancy between modalities, the addition of UEA to TTE aided in WT determination and improved correlation with MRI in those with greater WT and in all patients with myocardial scars.

Citing Articles

The Apple May Fall Far From the Family Tree in Hypertrophic Cardiomyopathy.

Reza N J Am Coll Cardiol. 2024; 84(19):1866-1868.

PMID: 39365228 PMC: 11524761. DOI: 10.1016/j.jacc.2024.08.066.

References

Igata S, Kraushaar M, Strachan M, Ma J, Nishimura M, Raisinghani A . Systematic Assessment of the Impact of Ultrasound-Enhancing Agents upon Measurements of Cardiac Size and Function by Echocardiography. J Am Soc Echocardiogr. 2019; 33(3):313-321. DOI: 10.1016/j.echo.2019.09.019. View

Kurt M, Shaikh K, Peterson L, Kurrelmeyer K, Shah G, Nagueh S . Impact of contrast echocardiography on evaluation of ventricular function and clinical management in a large prospective cohort. J Am Coll Cardiol. 2009; 53(9):802-10. DOI: 10.1016/j.jacc.2009.01.005. View

Lang R, Bierig M, Devereux R, Flachskampf F, Foster E, Pellikka P . Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of.... J Am Soc Echocardiogr. 2005; 18(12):1440-63. DOI: 10.1016/j.echo.2005.10.005. View

Urbano-Moral J, Gonzalez-Gonzalez A, Maldonado G, Gutierrez-Garcia-Moreno L, Vivancos-Delgado R, De Mora-Martin M . Contrast-Enhanced Echocardiographic Measurement of Left Ventricular Wall Thickness in Hypertrophic Cardiomyopathy: Comparison with Standard Echocardiography and Cardiac Magnetic Resonance. J Am Soc Echocardiogr. 2020; 33(9):1106-1115. DOI: 10.1016/j.echo.2020.04.009. View

Porter T, Mulvagh S, Abdelmoneim S, Becher H, Belcik J, Bierig M . Clinical Applications of Ultrasonic Enhancing Agents in Echocardiography: 2018 American Society of Echocardiography Guidelines Update. J Am Soc Echocardiogr. 2018; 31(3):241-274. DOI: 10.1016/j.echo.2017.11.013. View

Erden M, van Velzen H, Menting M, van den Bosch A, Ren B, Michels M . Three-dimensional echocardiography for the assessment of left ventricular geometry and papillary muscle morphology in hypertrophic cardiomyopathy. J Ultrasound. 2018; 21(1):17-24. PMC: 5845936. DOI: 10.1007/s40477-017-0277-y. View

Hoffmann R, von Bardeleben S, Ten Cate F, Borges A, Kasprzak J, Firschke C . Assessment of systolic left ventricular function: a multi-centre comparison of cineventriculography, cardiac magnetic resonance imaging, unenhanced and contrast-enhanced echocardiography. Eur Heart J. 2004; 26(6):607-16. DOI: 10.1093/eurheartj/ehi083. View

Hindieh W, Weissler-Snir A, Hammer H, Adler A, Rakowski H, Chan R . Discrepant Measurements of Maximal Left Ventricular Wall Thickness Between Cardiac Magnetic Resonance Imaging and Echocardiography in Patients With Hypertrophic Cardiomyopathy. Circ Cardiovasc Imaging. 2017; 10(8). DOI: 10.1161/CIRCIMAGING.117.006309. View

Ommen S, Mital S, Burke M, Day S, Deswal A, Elliott P . 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2020; 76(25):3022-3055. DOI: 10.1016/j.jacc.2020.08.044. View

10.

Chetrit M, Roujol S, Picard M, Timmins L, Manning W, Rudski L . Optimal Technique for Measurement of Linear Left Ventricular Dimensions. J Am Soc Echocardiogr. 2019; 32(4):476-483.e1. PMC: 7861507. DOI: 10.1016/j.echo.2018.12.001. View

11.

Lang R, Badano L, Mor-Avi V, Afilalo J, Armstrong A, Ernande L . Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015; 28(1):1-39.e14. DOI: 10.1016/j.echo.2014.10.003. View

12.

Geske J, Ommen S, Gersh B . Hypertrophic Cardiomyopathy: Clinical Update. JACC Heart Fail. 2018; 6(5):364-375. DOI: 10.1016/j.jchf.2018.02.010. View

13.

Porter T, Abdelmoneim S, Belcik J, McCulloch M, Mulvagh S, Olson J . Guidelines for the cardiac sonographer in the performance of contrast echocardiography: a focused update from the American Society of Echocardiography. J Am Soc Echocardiogr. 2014; 27(8):797-810. DOI: 10.1016/j.echo.2014.05.011. View

14.

Moreno F, Hagan A, Holmen J, Pryor T, STRICKLAND R, Castle C . Evaluation of size and dynamics of the inferior vena cava as an index of right-sided cardiac function. Am J Cardiol. 1984; 53(4):579-85. DOI: 10.1016/0002-9149(84)90034-1. View

15.

Nagueh S, Bierig S, Budoff M, Desai M, Dilsizian V, Eidem B . American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with hypertrophic cardiomyopathy: Endorsed by the American Society of Nuclear Cardiology, Society for Cardiovascular Magnetic.... J Am Soc Echocardiogr. 2011; 24(5):473-98. DOI: 10.1016/j.echo.2011.03.006. View

16.

Elliott P, Poloniecki J, Dickie S, Sharma S, Monserrat L, Varnava A . Sudden death in hypertrophic cardiomyopathy: identification of high risk patients. J Am Coll Cardiol. 2000; 36(7):2212-8. DOI: 10.1016/s0735-1097(00)01003-2. View

17.

Spirito P, BELLONE P, Harris K, Bernabo P, Bruzzi P, Maron B . Magnitude of left ventricular hypertrophy and risk of sudden death in hypertrophic cardiomyopathy. N Engl J Med. 2000; 342(24):1778-85. DOI: 10.1056/NEJM200006153422403. View

18.

Zoghbi W, Enriquez-Sarano M, Foster E, Grayburn P, Kraft C, Levine R . Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 2003; 16(7):777-802. DOI: 10.1016/S0894-7317(03)00335-3. View

19.

Bois J, Geske J, Foley T, Ommen S, Pellikka P . Comparison of Maximal Wall Thickness in Hypertrophic Cardiomyopathy Differs Between Magnetic Resonance Imaging and Transthoracic Echocardiography. Am J Cardiol. 2016; 119(4):643-650. DOI: 10.1016/j.amjcard.2016.11.010. View

20.

Spirito P, Autore C, Rapezzi C, Bernabo P, Badagliacca R, Maron M . Syncope and risk of sudden death in hypertrophic cardiomyopathy. Circulation. 2009; 119(13):1703-10. DOI: 10.1161/CIRCULATIONAHA.108.798314. View