Author + information
- Received November 26, 2017
- Revision received January 31, 2018
- Accepted February 1, 2018
- Published online July 1, 2019.
- Olivier Villemain, MDa,b,
- Mafalda Correia, PhDa,
- Elie Mousseaux, MD, PhDc,
- Jérome Baranger, MSa,
- Samuel Zarka, MDb,
- Ilya Podetti, MSa,
- Gilles Soulat, MDc,
- Thibaud Damy, MD, PhDd,
- Albert Hagège, MD, PhDb,
- Mickael Tanter, PhDa,
- Mathieu Pernot, PhDa,∗∗ ( and )
- Emmanuel Messas, MD, PhDb,∗
- aInstitut Langevin, ESPCI, CNRS, Inserm U979, PSL Research University, Paris, France
- bHôpital Européen Georges Pompidou, Université Paris Descartes, Cardio-Vascular Departement, UMR 970, Paris, France
- cHôpital Européen Georges Pompidou, Université Paris Descartes, Département de Radiologie, INSERM U970, Paris, France
- dDepartment of Cardiology, AP-HP, Henri Mondor Teaching Hospital, Créteil, France
- ↵∗Address for correspondence
: Dr. Mathieu Pernot, Institut Langevin, ESPCI, CNRS, Inserm U979, PSL Research University, 17 rue Moreau, 75012 Paris, France.
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)
↵∗ Drs. Pernot and Messas contributed to equally to this work, and are joint senior authors.
This study was supported by the European Research Council (ERC) under the European Union’s Seventh Framework Programme (FP/2007–2013)/ERC grant agreement 311025 and by the French Society of Cardiology. Dr. Damy has received support from Pfizer, GlaxoSmithKline, Prothena, Novartis, and Resmed. Dr. Tanter is cofounder of and shareholder with SuperSonic Imagine. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 26, 2017.
- Revision received January 31, 2018.
- Accepted February 1, 2018.
- 2018 The Authors