ABC | Volume 113, Nº4, October 2019

Original Article Strain Analysis of Left Ventricular Function in the Association of Hypertrophic Cardiomyopathy and Systemic Arterial Hypertension Thereza Cristina Pereira Gil, 1 Marcia Bueno Castier, 1 Alyne Freitas Pereira Gondar, 1 Ana Ferreira Sales, 1 Marceli de Oliveira Santos, 2 Fernanda Cristina da Silva de Lima, 3 Ricardo Mourilhe-Rocha 1 Universidade do Estado do Rio de Janeiro, 1 Rio de Janeiro, RJ – Brazil Instituto Nacional de Câncer, 2 Rio de Janeiro, RJ – Brazil Instituto Biomédico - Universidade Federal Fluminense, 3 Niterói, RJ – Brazil Mailing Address: Thereza Cristina Pereira Gil • Universidade do Estado do Rio de Janeiro - PGCM UERJ - Av. Prof. Manoel de Abreu, 444, 2º andar. Postal Code 20550-170, Vila Isabel, RJ – Brazil E-mail: thegil@terra.com.br Manuscript received October 04, 2018, revised manuscript January 03, 2019, accepted January 30, 2019 DOI: 10.5935/abc.20190176 Abstract Background: Hypertrophic cardiomyopathy (HCM) is the most common heart disease of genetic origin in the world population, with a prevalence of at least 1/500. The association with systemic arterial hypertension (SAH) is not uncommon, as it affects approximately 25% of the world population. Most studies aim at the differential diagnosis between these diseases, but little is known about the magnitude of this association. Objective: To compare left ventricular global longitudinal strain (GLS) in HCM patients with and without associated SAH. Methods: Retrospective cross-sectional study that included 45 patients with HCM and preserved ejection fraction, with diagnosis confirmed bymagnetic resonance imaging, including 14 hypertensive patients. Transthoracic echocardiography was performed, with emphasis on left ventricular myocardial strain analysis using GLS. In this study, p < 0.05 was considered statistically significant. Results: Left ventricular strain was significantly lower in hypertensive individuals compared to normotensive individuals (–10.29 ± 2.46 vs. –12.35% ± 3.55%, p = 0.0303), indicating greater impairment of ventricular function in that group. Mean age was also significantly higher in hypertensive patients (56.1 ± 13.9 vs. 40.2 ± 12.7 years, p = 0.0001). Diastolic dysfunction was better characterized in hypertensive patients (p = 0.0242). Conclusion: Myocardial strain was significantly lower in the group of patients with HCM and SAH, suggesting greater impairment of ventricular function. This finding may be related to a worse prognosis with early evolution to heart failure. Prospective studies are required to confirm this hypothesis. (Arq Bras Cardiol. 2019; 113(4):677-684) Keywords: Ventricular Function, Left; Cardiomyopathy, Hypertrophic; Hypertension; Strain; Heart Failure. Introduction The first cases of hypertrophic cardiomyopathy (HCM) were published in the 1860s, in France, related to left ventricular outflow tract obstruction. 1 In 1957, Brock authored the first report based on hemodynamic, surgical and necropsy findings, describing the disease as subvalvar aortic stenosis with functional left ventricular obstruction, which may be related to systemic arterial hypertension (SAH). 2 In 1958, Teare published the first histopathological description of obstructive HCM. 3 The nonobstructive form was described by Braunwauld et al. in 1963, and confirmed by subsequent studies. 4,5 HCM is currently defined as the primary myocardial disease of genetic origin with the highest prevalence in the world population (at least 1/500), regardless of ethnicity, sex or age, being the leading cause of sudden death in young people. 5,6 It results from the mutation of one or more sarcomere genes, presenting significant diversity in phenotypic expression and clinical course. It is characterized by an increase in ventricular wall thickness that cannot be explained by an overload condition alone. The non‑obstructive formof the disease ismore frequent. 5,7 SAH affects approximately 25% of the world population. Data from VIGITEL (2006-2014) and the World Health Organization confirm this prevalence in the Brazilian population. 8,9 Due to the high prevalence of SAH, the association of SAH and HCM is not uncommon. Differential diagnosis between HCM and hypertensive heart disease has been a challenge in many situations where the phenotypic expression of these diseases is similar. 10 In this context, echocardiography has become an important tool, especially with the advent of new technologies, such as myocardial strain analysis, which assists differential diagnosis. Besides, global longitudinal strain (GLS) analysis detects early abnormalities in ventricular function before impairment of ejection fraction. 11,12 The purpose of this study was to compare left ventricular GLS in HCMpatients with and without SAH, and to assess the impact of this association on ventricular function. 677