Myocardial Stiffness Evaluation Using Noninvasive Shear Wave Imaging in Healthy and Hypertrophic Cardiomyopathic Adults

Olivier Villemain, Mafalda Correia, Elie Mousseaux, Jérome Baranger, Samuel Zarka, Ilya Podetti, Gilles Soulat, Thibaud Damy, Albert Hagège, Mickael Tanter, Mathieu Pernot, Emmanuel Messas, Olivier Villemain, Mafalda Correia, Elie Mousseaux, Jérome Baranger, Samuel Zarka, Ilya Podetti, Gilles Soulat, Thibaud Damy, Albert Hagège, Mickael Tanter, Mathieu Pernot, Emmanuel Messas

Abstract

Objectives: The goal of our study was to investigate the potential of myocardial shear wave imaging (SWI) to quantify the diastolic myocardial stiffness (MS) (kPa) noninvasively in adult healthy volunteers (HVs) and its physiological variation with age, and in hypertrophic cardiomyopathy (HCM) populations with heart failure and preserved ejection function (HFpEF).

Background: MS is an important prognostic and diagnostic parameter of the diastolic function. MS is affected by physiological changes but also by pathological alterations of extracellular and cellular tissues. However, the clinical assessment of MS and the diastolic function remains challenging. SWI is a novel ultrasound-based technique that has the potential to provide intrinsic MS noninvasively.

Methods: We prospectively included 80 adults: 60 HV (divided into 3 groups: 20- to 39-year old patients [n = 20]; 40- to 59-year-old patients [n = 20]; and 60- to 79-year-old patients [n = 20]) and 20 HCM-HFpEF patients. Echocardiography, cardiac magnetic resonance imaging and biological explorations were achieved. MS evaluation was performed using an ultrafast ultrasound scanner with cardiac phased array. The fractional anisotropy of MS was also estimated.

Results: MS increased significantly with age in the HV group (the mean MS was 2.59 ± 0.58 kPa, 4.70 ± 0.88 kPa, and 6.08 ± 1.06 kPa for the 20- to 40-year-old, 40- to 60-year-old, and 60- to 80-year-old patient groups, respectively; p < 0.01 between each group). MS was significantly higher in HCM-HFpEF patients than in HV patients (mean MS = 12.68 ± 2.91 kPa vs. 4.47 ± 1.68 kPa, respectively; p < 0.01), with a cut-off at 8 kPa (area under the curve = 0.993; sensitivity = 95%, specificity = 100%). The fractional anisotropy was lower in HCM-HFpEF (mean = 0.133 ± 0.073) than in HV (0.238 ± 0.068) (p < 0.01). Positive correlations were found between MS and diastolic parameters in echocardiography (early diastolic peak/early diastolic mitral annular velocity, r = 0.783; early diastolic peak/transmitral flow propagation velocity, r = 0.616; left atrial volume index, r = 0.623) and with fibrosis markers in cardiac magnetic resonance (late gadolinium enhancement, r = 0.804; myocardial T1 pre-contrast, r = 0.711).

Conclusions: MS was found to increase with age in healthy adults and was significantly higher in HCM-HFpEF patients. Myocardial SWI has the potential to become a clinical tool for the diagnostic of diastolic dysfunction. (Non-invasive Evaluation of Myocardial Stiffness by Elastography [Elasto-Cardio]; NCT02537041).

Keywords: diastolic function; echocardiography; myocardial stiffness; myocardium.

Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Figures

Graphical abstract
Graphical abstract
Figure 1
Figure 1
Myocardial Shear Wave Imaging B-mode and shear wave elastography imaging examples of a healthy volunteer (HV). Shear wave propagation in short- and long-axis views of a HV (tissue axial velocity images). Also see Video 1. AV = atrioventricular; LA = left atrium; LV = left ventricle; LVOT = left ventricular outflow tract; MV = mitral valve; RV = right ventricle; RVOT = right ventricular outflow tract; SA = short axis view.
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/6603249/bin/grv1.jpg
Video 1
Figure 2
Figure 2
Study Flowchart The study was performed on 60 healthy volunteer and 20 HCM patients. CMR = cardiac magnetic resonance; HCM = hypertrophic cardiomyopathy; HFpEF = heart failure with preserved ejection fraction.
Figure 3
Figure 3
Myocardial Stiffness for Healthy Volunteers Myocardial stiffness measured in HV as a function of age. Abbreviation as in Figure 1.
Figure 4
Figure 4
Myocardial Stiffness in HCM and HV Groups Comparison of Myocardial Stiffness between healthy volunteer group (HV) and hypertrophic cardiomyopathy with HFpEF group (HCM group). AUC = area under the curve; MS = myocardial stiffness; ROC = receiver-operating curve; Se = sensitivity; Sp = specificity; other abbreviations as in Figures 1 and 2.
Figure 5
Figure 5
Fractional Anisotropy Comparison of fractional anisotropy (FA) between healthy volunteer group (HV) and hypertrophic cardiomyopathy with HFpEF group (HCM group).

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