Layer‐specific strain echocardiography may reflect regional myocardial impairment in patients with hypertrophic cardiomyopathy

Our study aimed to determine whether layer-specific strain (LSS) could reflect regional myocardial impairment in patients with hypertrophic cardiomyopathy (HCM). The study enrolled 50 patients with HCM and 30 age-matched healthy controls. Transmural gradient of longitudinal strain (TGLS), defined as the difference between the longitudinal strain of the endocardium and epicardium in a left ventricular segment, was used to reflect layer-specific myocardial impairment. Negative TGLS was consistently observed in healthy controls. The TGLS was relatively consistent within the basal, middle, and apical levels in healthy controls,but showed a significant gradient from the base towards the apex. In patients with HCM, the hypertrophic segments had significantly higher TGLS than the relatively normal segments or healthy controls at all 3 levels (0.14 % ± 3.48 % vs. −2.65 % ± 4.44 % vs. −2.17 % ± 1.66 % for basal, − 0.72 % ± 3.71 % vs. −4.02 % ± 4.00 % vs. −3.58 % ± 2.29 % for middle, and − 8.69 % ± 7.96 % vs. −11.44 % ± 6.65 % vs. −10.04 % ± 3.20 % for apex). Abnormal TGLS, defined as positive TGLS, in patients with HCM was associated with chest pain. In receiver operating characteristic curve analysis, a large area of abnormal TGLS (> 4 segments) had moderate accuracy for predicting chest pain (sensitivity, 73.3 %; specificity, 70.0 %). TGLS, a novel LSS derived parameter, may reflect regional myocardial impairment in patients with HCM.