Lowering the Recommended Maximal Wall Thickness Threshold Improves Diagnostic Sensitivity in Asians With Hypertrophic Cardiomyopathy
Background: Hypertrophic cardiomyopathy (HCM) is defined as left ventricular end-diastolic maximal wall thickness (WTMax) ≥15.0 mm, without accounting for ethnicity, sex, and body size. It is well-established that Asians have smaller hearts than do Caucasians. Objectives: This study aims to examine...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-09-01
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| Series: | JACC: Asia |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772374721000703 |
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| author | Thu-Thao Le, PhD Benjamin Huang, MD Chee Jian Pua, PhD Vineet Tornekar, MD Annette Schumacher-Maurer, MD Desiree-Faye Toh, MSc Jennifer Bryant, PhD Briana Ang, BSc Ben Corden, PhD Sanjay K. Prasad, MD Hak-Chiaw Tang, MBBS Stuart A. Cook, MD, PhD Calvin W.L. Chin, MD, PhD |
| author_facet | Thu-Thao Le, PhD Benjamin Huang, MD Chee Jian Pua, PhD Vineet Tornekar, MD Annette Schumacher-Maurer, MD Desiree-Faye Toh, MSc Jennifer Bryant, PhD Briana Ang, BSc Ben Corden, PhD Sanjay K. Prasad, MD Hak-Chiaw Tang, MBBS Stuart A. Cook, MD, PhD Calvin W.L. Chin, MD, PhD |
| author_sort | Thu-Thao Le, PhD |
| collection | DOAJ |
| description | Background: Hypertrophic cardiomyopathy (HCM) is defined as left ventricular end-diastolic maximal wall thickness (WTMax) ≥15.0 mm, without accounting for ethnicity, sex, and body size. It is well-established that Asians have smaller hearts than do Caucasians. Objectives: This study aims to examine the implications of this single absolute WTMax threshold on the diagnosis of HCM in Asians. Methods: The study consisted of 360 healthy volunteers (male: n = 174; age: 50 ± 12 years) and 114 genetically characterized patients with HCM (male: n = 83; age: 52 ± 13 years; genotype-positive, n = 39). All participants underwent cardiovascular magnetic resonance. WTMax was measured semiautomatically at end-diastole according to the standard 16 myocardial segments. Results: Healthy male volunteers had increased WTMax compared with that of female volunteers (8.4 ± 1.2 mm vs 6.6 ± 1.1 mm, respectively; P < 0.001). Conversely, WTMax was similar between male and female patients with HCM (15.2 ± 3.4 mm vs 14.7 ± 3.0 mm, respectively; P = 0.484) and between those with and without a pathogenic gene variant (P = 0.828). Using the recommended diagnostic threshold of 15.0 mm, 56 patients with HCM had WTMax <15.0 mm and no healthy volunteers had WTMax >15.0 mm (specificity of 100% and sensitivity of 51%). Lowering WTMax thresholds to 10.0 mm in female patients and 12.0 mm in male patients did not affect specificity (100%) but significantly improved sensitivity (84%). Despite lower left ventricular mass, female patients with HCM demonstrated more features of adverse cardiac remodeling than did male patients: increased myocardial fibrosis, higher asymmetric ratio, and disproportionately worse myocardial strain. Conclusions: The study highlights cautious application of guideline-recommended WTMax to diagnose HCM in Asians. Lowering WTMax to account for ethnicity and sex improves diagnostic sensitivity without compromising specificity. |
| first_indexed | 2024-12-17T12:22:37Z |
| format | Article |
| id | doaj.art-8d800728bfbd47f0ba5108a6c13f1a7f |
| institution | Directory Open Access Journal |
| issn | 2772-3747 |
| language | English |
| last_indexed | 2024-12-17T12:22:37Z |
| publishDate | 2021-09-01 |
| publisher | Elsevier |
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| series | JACC: Asia |
| spelling | doaj.art-8d800728bfbd47f0ba5108a6c13f1a7f2022-12-21T21:48:55ZengElsevierJACC: Asia2772-37472021-09-0112218226Lowering the Recommended Maximal Wall Thickness Threshold Improves Diagnostic Sensitivity in Asians With Hypertrophic CardiomyopathyThu-Thao Le, PhD0Benjamin Huang, MD1Chee Jian Pua, PhD2Vineet Tornekar, MD3Annette Schumacher-Maurer, MD4Desiree-Faye Toh, MSc5Jennifer Bryant, PhD6Briana Ang, BSc7Ben Corden, PhD8Sanjay K. Prasad, MD9Hak-Chiaw Tang, MBBS10Stuart A. Cook, MD, PhD11Calvin W.L. Chin, MD, PhD12Department of Cardiology, National Heart Centre Singapore, Singapore; Cardiovascular Academic Clinical Program, Duke NUS Medical School, SingaporeDepartment of Cardiology, National Heart Centre Singapore, SingaporeDepartment of Cardiology, National Heart Centre Singapore, Singapore; Yong Loo Lin School of Medicine, National University Singapore, SingaporeDepartment of Cardiology, National Heart Centre Singapore, SingaporeDepartment of Cardiology, National Heart Centre Singapore, SingaporeDepartment of Cardiology, National Heart Centre Singapore, SingaporeDepartment of Cardiology, National Heart Centre Singapore, SingaporeDepartment of Cardiology, National Heart Centre Singapore, SingaporeDepartment of Cardiology, National Heart Centre Singapore, Singapore; National Heart and Lung Institute, Imperial College, London, United KingdomNational Heart and Lung Institute, Imperial College, London, United Kingdom; Royal Brompton Hospital, London, United KingdomDepartment of Cardiology, National Heart Centre Singapore, Singapore; Cardiovascular Academic Clinical Program, Duke NUS Medical School, SingaporeDepartment of Cardiology, National Heart Centre Singapore, Singapore; Cardiovascular Academic Clinical Program, Duke NUS Medical School, SingaporeDepartment of Cardiology, National Heart Centre Singapore, Singapore; Cardiovascular Academic Clinical Program, Duke NUS Medical School, Singapore; Address for correspondence: Dr Calvin Woon-Loong Chin, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609.Background: Hypertrophic cardiomyopathy (HCM) is defined as left ventricular end-diastolic maximal wall thickness (WTMax) ≥15.0 mm, without accounting for ethnicity, sex, and body size. It is well-established that Asians have smaller hearts than do Caucasians. Objectives: This study aims to examine the implications of this single absolute WTMax threshold on the diagnosis of HCM in Asians. Methods: The study consisted of 360 healthy volunteers (male: n = 174; age: 50 ± 12 years) and 114 genetically characterized patients with HCM (male: n = 83; age: 52 ± 13 years; genotype-positive, n = 39). All participants underwent cardiovascular magnetic resonance. WTMax was measured semiautomatically at end-diastole according to the standard 16 myocardial segments. Results: Healthy male volunteers had increased WTMax compared with that of female volunteers (8.4 ± 1.2 mm vs 6.6 ± 1.1 mm, respectively; P < 0.001). Conversely, WTMax was similar between male and female patients with HCM (15.2 ± 3.4 mm vs 14.7 ± 3.0 mm, respectively; P = 0.484) and between those with and without a pathogenic gene variant (P = 0.828). Using the recommended diagnostic threshold of 15.0 mm, 56 patients with HCM had WTMax <15.0 mm and no healthy volunteers had WTMax >15.0 mm (specificity of 100% and sensitivity of 51%). Lowering WTMax thresholds to 10.0 mm in female patients and 12.0 mm in male patients did not affect specificity (100%) but significantly improved sensitivity (84%). Despite lower left ventricular mass, female patients with HCM demonstrated more features of adverse cardiac remodeling than did male patients: increased myocardial fibrosis, higher asymmetric ratio, and disproportionately worse myocardial strain. Conclusions: The study highlights cautious application of guideline-recommended WTMax to diagnose HCM in Asians. Lowering WTMax to account for ethnicity and sex improves diagnostic sensitivity without compromising specificity.http://www.sciencedirect.com/science/article/pii/S2772374721000703asymmetrical hypertrophycardiovascular magnetic resonancehypertrophic cardiomyopathysex-specific diagnostic thresholds |
| spellingShingle | Thu-Thao Le, PhD Benjamin Huang, MD Chee Jian Pua, PhD Vineet Tornekar, MD Annette Schumacher-Maurer, MD Desiree-Faye Toh, MSc Jennifer Bryant, PhD Briana Ang, BSc Ben Corden, PhD Sanjay K. Prasad, MD Hak-Chiaw Tang, MBBS Stuart A. Cook, MD, PhD Calvin W.L. Chin, MD, PhD Lowering the Recommended Maximal Wall Thickness Threshold Improves Diagnostic Sensitivity in Asians With Hypertrophic Cardiomyopathy JACC: Asia asymmetrical hypertrophy cardiovascular magnetic resonance hypertrophic cardiomyopathy sex-specific diagnostic thresholds |
| title | Lowering the Recommended Maximal Wall Thickness Threshold Improves Diagnostic Sensitivity in Asians With Hypertrophic Cardiomyopathy |
| title_full | Lowering the Recommended Maximal Wall Thickness Threshold Improves Diagnostic Sensitivity in Asians With Hypertrophic Cardiomyopathy |
| title_fullStr | Lowering the Recommended Maximal Wall Thickness Threshold Improves Diagnostic Sensitivity in Asians With Hypertrophic Cardiomyopathy |
| title_full_unstemmed | Lowering the Recommended Maximal Wall Thickness Threshold Improves Diagnostic Sensitivity in Asians With Hypertrophic Cardiomyopathy |
| title_short | Lowering the Recommended Maximal Wall Thickness Threshold Improves Diagnostic Sensitivity in Asians With Hypertrophic Cardiomyopathy |
| title_sort | lowering the recommended maximal wall thickness threshold improves diagnostic sensitivity in asians with hypertrophic cardiomyopathy |
| topic | asymmetrical hypertrophy cardiovascular magnetic resonance hypertrophic cardiomyopathy sex-specific diagnostic thresholds |
| url | http://www.sciencedirect.com/science/article/pii/S2772374721000703 |
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