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Background <p>To compare myocardial functional states and explore the relationship between myocardial thickness and function in patients with hypertrophic cardiomyopathy (HCM) versus hypertensive left ventricular hypertrophy (HTN-LVH) using advanced echocardiographic techniques: speckle tracking echocardiography-derived longitudinal strain (STE-LS) and pressure-strain loop-based myocardial work (PSL-MW).</p> Methods <p>Global and segmental myocardial function was assessed using STE-LS and PSL-MW indices and compared among HCM, HTN-LVH, and healthy control groups. Associations between segmental myocardial thickness and functional parameters were analyzed using linear mixed-effects models (LMMs).</p> Results <p>A total of 104 participants were enrolled, including 33 patients with HCM (all asymmetric hypertrophy), 33 with HTN-LVH (18 diffuse thickening, 15 focal thickening), and 38 healthy controls. Both HCM and HTN-LVH groups exhibited impaired global myocardial function compared to controls, with significantly greater impairment observed in HCM (all <i>P</i> &lt; 0.05). Crucially, HCM demonstrated impaired regional strain and work indices even in segments of normal thickness, whereas HTN-LVH preserved normal function in segments of comparable thickness. LMMs revealed a significant inverse correlation between myocardial thickness and function, as quantified by LS and myocardial work index (MWI). However, this inverse thickness-function relationship was significantly attenuated in HCM (β = 0.56, <i>P</i> = 0.031 for LS; β = 91.14, <i>P</i> &lt; 0.001 for MWI) but preserved in HTN-LVH.</p> Conclusion <p>HCM is characterized by myocardial dysfunction independent of structural hypertrophy, accompanied by a significant attenuation of the physiological inverse thickness-function relationship. Conversely, HTN-LVH maintains intact function in non-hypertrophied myocardium and physiological adaptation to hypertrophy. STE-LS and PSL-MW facilitate differential diagnosis between the two conditions.</p>

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Divergent myocardial functional adaptation in hypertrophic cardiomyopathy versus hypertensive left ventricular hypertrophy: insights from longitudinal strain and non-invasive myocardial work

  • 期刊论文

  • 发表日期：

    2026年2月5日

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  • HanLu Lv,
  • Qiong Qiu,
  • JingFeng Wang,
  • YingMei Liu

摘要

Background

To compare myocardial functional states and explore the relationship between myocardial thickness and function in patients with hypertrophic cardiomyopathy (HCM) versus hypertensive left ventricular hypertrophy (HTN-LVH) using advanced echocardiographic techniques: speckle tracking echocardiography-derived longitudinal strain (STE-LS) and pressure-strain loop-based myocardial work (PSL-MW).

Methods

Global and segmental myocardial function was assessed using STE-LS and PSL-MW indices and compared among HCM, HTN-LVH, and healthy control groups. Associations between segmental myocardial thickness and functional parameters were analyzed using linear mixed-effects models (LMMs).

Results

A total of 104 participants were enrolled, including 33 patients with HCM (all asymmetric hypertrophy), 33 with HTN-LVH (18 diffuse thickening, 15 focal thickening), and 38 healthy controls. Both HCM and HTN-LVH groups exhibited impaired global myocardial function compared to controls, with significantly greater impairment observed in HCM (all P < 0.05). Crucially, HCM demonstrated impaired regional strain and work indices even in segments of normal thickness, whereas HTN-LVH preserved normal function in segments of comparable thickness. LMMs revealed a significant inverse correlation between myocardial thickness and function, as quantified by LS and myocardial work index (MWI). However, this inverse thickness-function relationship was significantly attenuated in HCM (β = 0.56, P = 0.031 for LS; β = 91.14, P < 0.001 for MWI) but preserved in HTN-LVH.

Conclusion

HCM is characterized by myocardial dysfunction independent of structural hypertrophy, accompanied by a significant attenuation of the physiological inverse thickness-function relationship. Conversely, HTN-LVH maintains intact function in non-hypertrophied myocardium and physiological adaptation to hypertrophy. STE-LS and PSL-MW facilitate differential diagnosis between the two conditions.