P349In patients with hypertrophic cardiomyopathy myocardial fibrosis is associated with both left ventricular and left atrial dysfunction.

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Aims: To assess left (LV) and right ventricular (RV) function by two-dimensional speckle tracking echocardiography and its relation to myocardial fibrosis in hypertrophic cardiomyopathy (HCM).Methods: We enrolled 50 HCM patients (30 male; 47.3±9.9 years) in our study. Each patient received echocardiography with modern high-end scanners (GE Medical Systems, Vivid 7, Horten, Norway). For speckle-tracking analysis of LV and RV function the dedicated software (EchoPac PC, same vendor) was used. The presence of myocardial fibrosis was detected by cardiac magnetic resonance imaging (MRI).Results: We found a correlation of r=0.89 (p<0.001) for intra-observer variability of RV global longitudinal strain with a minor bias of 4.9±2.9 %. With cardiac MRI 30 patients (60%) demonstrated late gadolinium-enhancement (LGE) of the LV. Of these patients only 7% had LGE of the RV. HCM patients with myocardial fibrosis had less global longitudinal LV strain in comparison to patients without myocardial fibrosis (-12.8±2.2 vs. -21.1±2.6, p<0.001), thicker interventricular septums (23.7±4.0 vs. 19.2±5.1, p<0.001), larger left atria (34.9±7.1 vs. 23.9±5.1, p<0.001) and impaired diastolic function (E/A-ratio: 1.02±0.22 vs. 1.15±0.18, p<0.01). Comparable results were found for RV function. LV and RV strain correlated with r=0.85 (p<0.001).Conclusions: HCM is not only a disease of the LV. LGE in HCM is associated with both LV and RV dysfunction. Fibrosis seems to have a negative impact on disease progression. Although RV LGE occurs only in a minority of patients with HCM and LV fibrosis, speckle-tracking echocardiography is feasible for evaluating LV and RV remodeling in these patients.

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