Relationship between left ventricular multilayer global longitudinal strain and left atrial strain obtained by 'Speckle Tracking Echocardiography' specket tracking method and heart rate variability in patients with hypertrophic cardiomyopathy

OBJECTIVE:Our aim in this study is to evaluate systolic and diastolic functions with Left ventricular multilayer global longitudinal strain and left atrial strain obtained by the 'Speckle Tracking Echocardiography' method in HCM patients and to examine ventricular arrhythmias and heart rate variability obtained from holter recordings. MATERIALS AND METHODS: In the cross-sectional study, 51 people diagnosed with hypertrophic cardiomyopathy and followed up with this diagnosis for at least one year were included as the patient group. 33 healthy individuals, similar in age and gender to the patient group, were included as the control group. Echocardiographic examination was performed on all patients with the Philips Epiq 7 (Philips Medical Systems, Andover, MA, USA) echocardiography device. Patients were divided into two groups according to the presence/absence of LVOT (left ventricular outflow tract obstruction) 17 LVOT (+), 34 LVOT (-).Strain analysis was performed with the help of QLAB 13.0 (Advanced Quantification Software version; Philips) software. All patients and healthy controls underwent echocardiographic examination and were fitted with a 24-hour 3 and 5-channel rhythm Holter device, Cardioscan12 DMS. The records obtained were evaluated in a computer environment using CardioScan 12 software. RESULTS: In the HCM group, a statistically significant decrease was detected in endocardial, mid (transmural), epicardial GLS strain values compared to the control group consisting of healthy individuals.[(Endo GLS:%-16,6 vs %-21,0,p:0,000),(Mid GLS:%-15 vs %-18,8,p:0,000),(Epi GLS:%-13,7 vs %-17,8,p:0,000)] The strain values we obtained showed a positive correlation with proBNP values (biomarker). In our subgroup analysis based on the presence/absence of LVOT; there was no statistically significant difference between the groups in LV (Left ventricle) multilayer GLS values(endo mid epi respectively p:0,184,p:358,p:384), but as an absolute value, the GLS value in all three layers was lower in the LVOT (+) group. Considering the difference in numbers between the patient groups, the difference may gain statistical significance in a larger study by increasing the number of patients. In our study, statistically significantly more NSVT was detected in the patient group than in the control group(p:0,026). The reason for the decrease in multilayer GLS and the frequency of NSVT may be the fibrotic scar tissues and the early effects on systolic functions in HCM patients. We found a statistically significant higher frequency of family history of sudden death in HCM patients with genetic inheritance compared to the control group(p:0,041). Left atrial strain examination plays an important role in the diagnosis of diastolic dysfunction, which plays a role in pathogenesis in HCM patients. In our thesis study, we detected a statistically significant absolute decrease in LARS, LARSP, LACD, LACDP values in left atrial strain HCM patients compared to the control group(LARS,LARSP,LACD ,LACDP p:0,000). Left atrial size and LAVI measurements were evaluated to be significantly larger[(LA:42,1 vs 36,06 p:0,000)(LAVI: 36,0 vs 24,5,p:0,000)]. In addition, a correlation was observed in many of the left atrial strain parameters with diastolic dysfunction diagnostic criteria used in conventional echocardiography, such as LAVI and E/e'. In this thesis, we also examined the relationship of HRV parameters with arrhythmias and multilayer GLS and left atrial strain. No statistically significant difference was found between the control group and the patient group, except for the HF parameter(p:0,002), and the difference was not seen in other parameters. Considering the publications on the HRV corrective effect of beta-blocker treatment, the lack of a statistically significant difference may be related to the intensive beta-blocker use rate of the patients CONCLUSION: Our study is important in terms of the evaluation of the early effects of systolic and diastolic functions in patients diagnosed with HCM by speckle tracking echocardiography and its relationship with ventricular arrhythmias. More comprehensive studies are needed in terms of mutation analysis of sarcomere proteins of the disease, whose genetic transmission has been shown, and the relationship of multilayer GLS examination with cardiac MRI detection of fibrotic foci where arrhythmias develop.