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June 18, 2020 — Journal of the American Society of Echocardiography (JASE)



Left ventricular wall thickness (LVWT) measurement is key in the diagnostic and prognosticassessment of hypertrophic cardiomyopathy (HCM). Recent investigations have highlighteddiscrepancies in LVWT by cardiac magnetic resonance (CMR) and standard echocardiography(S-Echo) in this condition. The aim of this study was to elucidate the role of contrast-enhancedechocardiography (C-Echo) to optimize LVWT measurement in patients with HCM.


Fifty patients with HCM were prospectively enrolled, undergoing S-Echo, C-Echo, andCMR. Blinded LVWT measurements were performed according to a 16-segment left ventricularmodel using all three imaging techniques. Agreement between both echocardiographicmodalities and CMR (as the reference technique) at the segmental level was testedusing Bland-Altman analyses. Reproducibility on segmental measurements by S-Echo andC-Echo was also investigated.


Patients’ mean age was 47 ± 21 years, and 35 (70%) were men. Maximal mean LVWT byS-Echo (20.1 ± 3.8 mm) was greater than the values derived using C-Echo (17.6 ± 4.0 mm, P < .01) and CMR (17.7 ± 4.5 mm, P < .01), with no statistically significant difference between the latter two. SegmentalBland-Altman models demonstrated globally smaller bias and narrower 95% limits ofagreement for C-Echo compared with S-Echo. Across all left ventricular segments, LVWTby C-Echo was 2.4 mm lower (range, 1.0–2.5 mm) than that derived by S-Echo, whichaccounted for a 25% intertechnique difference. Regarding maximal LVWT, the mean absolutedifference between C-Echo and S-Echo was 3.0 ± 1.9 mm (range, 0.0–7.9 mm), which representeda 15% intertechnique change. Data analyses demonstrated globally less intra- and interobservervariability in segmental LVWT derived from C-Echo compared with S-Echo.


C-Echo rendered LVWT measurements closer to those derived by the reference technique(CMR) and improved reproducibility compared with S-Echo. C-Echo represents a suitabletool for LVWT measurement in patients with HCM as an alternative to CMR whenever thisis not available or possible.

Authors: Jose Angel Urbano-Moral, MD, PhD; Ana Maria Gonzalez-Gonzalez, MD, PhD; Giuliana Maldonado, MD; Manuel De Mora-Martin, MD, PhD, Jose Fernando Rodriguez-Palomares, MD, PhD; Arturo Evangelista-Masip, MD, PhD

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