CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 3, July/August 2023 AFRICA 171 interquartile range (IQR), respectively. Two-group comparisons were done with the independent sample’s t-test or Mann– Whitney U-test. Correlation of papillary muscle strain with other parameters was done with Spearman’s correlation analysis. Receiver operating characteristic (ROC) curve analysis was conducted in order to find ALPM and PMPM strain values for the prediction of HCMP. A two-tailed p-value < 0.05 was accepted as significant. An intraclass correlation coefficient model was used to examine intra-observer variability. Results The mean ages of HCMP and HT patients were 53.85 ± 15.46 and 56.60 ± 12.05 years, respectively. Of the 46 HCMP patients, 30 (65.2%) were male and 16 (34.8) were female. Of the 40 hypertensive patients, 33 (82.5%) were male and seven (17.5) were female. We did not find any differences with regard to age, gender ratio, body mass index and body surface area of the two groups. Although the HT patients had slightly higher systolic and diastolic blood pressures, it did not reach statistical significance. Maximal wall thickness and IVS thickness were significantly higher in the HCMP patients compared to the HT patients. Similarly, IVS/PW ratio, LVMI and LAAP diameter were found to be more increased in patients with HCMP than in the HT patients. Left ventricular cavity dimensions were smaller in the HCMP patients: LVEDD were 45 (40–47.2) and 48 (46–50) mm, and LVESD were 24.97 ± 5.28 and 28.17 ± 3.58 mm in the HCMP and HT patients, respectively. Mitral E/E′ was significantly higher in the HCMP patients compared to the HT patients (15.96 ± 7.51 vs 11.02 ± 2.79, respectively, p = 0.032). There were no significant differences in pulsed-wave Doppler recordings of the mitral and tricuspid valves, except for the higher value of the mitral E velocity that reached statistical significance in patients with HCMP (77.47 ± 20.33 and 64.48 ± 13.11 ms, respectively; p = 0.002). Apical 4C, 2C, 3C longitudinal strain were significantly reduced in HCMP patients compared to the HT patients. GLS of HCMP and HT patients were –14.52 ± 3.01 and –16.85 ± 1.36%, respectively (p < 0.001). Likewise, ALPM and PMPM free strain values were significantly more reduced in the HCMP patients than in HT patients [–14.00 (–22 to –11%) and –15.5 (–24.02 to –10.16%) vs –23.00 (–24.99 to –19.01%) and –22.30 (–26.48 to –15.95%), p = 0.016 and p = 0.010], respectively. Table 1 shows a comparison of variables of the two groups and Fig. 2 depicts the GLS, and ALPM and PMPM free strain values of the two groups. Five (10.86%) patients with HCMP underwent implantable cardioverter-defibrillator (ICD) implantation, 12 (26.08%) had a family history of HCMP, and eight (17.39%) had a family history of sudden death. In patients with HCMP, the type of the hypertrophy was asymmetrical septal hypertrophy in 34 (73.91%) patients, concentric in 11 (23.91%) patients, and apical in one (2.18%) patient. One patient had apical aneurysm formation. Ten (21.73%), 14 (30.43%) and five (10.86%) patients had minimal, mild and moderate mitral regurgitation, respectively. Twenty-two (47.82%) patients had left ventricular outflow obstruction with a mean gradient of 80.50 ± 30.62 mmHg. ALPM free strain showed a statistically significant correlation with GLS (r = 0.604, p < 0.001), maximal wall thickness (r = 0.407, p = 0.032), IVS thickness (r = 0.425, p = 0.006) and LVMI (r = 0.465, p = 0.002) (Table 2). PMPM free strain showed a Table 1. Clinical and echocardiographic findings of HCMP and HT patients Variables HCMP patients (n = 46) HT patients (n = 50) p-value Age (years) 53.85 ± 15.46 56.60 ± 12.05 0.365 Gender, n (%) 0.068 Male 30 (65.2) 33 (82.5) Female 16 (34.8) 7 (17.5) Body mass index (kg/m2) 27.27 ± 4.77 27.38 ± 2.77 0.892 Body surface area (m2) 1.85 ± 0.32 1.88 ± 0.30 0.704 SBP (mmHg) 127.21 ± 23.37 131.05 ± 12.75 0.334 DBP (mmHg) 79.18 ± 13.01 84.65 ± 10.53 0.083 HR (bpm) 76.42 ± 13.77 73.88 ± 10.59 0.506 Maximal wall thickness (mm) 25.02 ± 5.84 15.33 ± 3.21 < 0.001 IVS thickness (mm) 2.35 (2.1–2.8) 1.5 (1.4–1.7) < 0.001 PW thickness (mm) 1.3 (1.1–1.4) 1.3 (1.2–1.5) 0.156 IVS/PW 1.85 ± 0.50 1.18 ± 0.24 < 0.001 LVMI (gr/m2) 202.82 (162.41–249.99) 161.26 (128.09–195.70) <0.001 LVEDD (mm) 45 (40–47.2) 48 (46–50) <0.001 LVESD (mm) 24.97 ± 5.28 28.17 ± 3.58 0.002 Aortic annulus (mm) 24 (22–26) 23 (22–24) 0.137 LAAP (mm) 40.25 ± 6.51 36.73 ± 2.73 0.005 TAPSE (mm) 20 (18.05–26.35) 16 (23–30) 0.006 Mitral E velocity (cm/s) 77.47 ± 20.33 64.48 ± 13.11 0.002 Mitral A velocity (cm/s) 69.10 (55.90–93.00) 64.00 (60.00–83.25) 0.970 E/A 1.0 (0.74–1.42) 0.84 (0.79–1.11) 0.180 DT (ms) 197.88 ± 72.19 232.33 ± 50.69 0.113 MPI 0.52 ± 0.12 0.46 ± 0.06 0.121 Tricuspid E velocity (cm/s) 52.50 ± 8.6 46.70 ± 11.94 0.174 Tricuspid A velocity (cm/s) 49.01 ± 10.83 42.73 ± 5.90 0.186 Tricuspid DT (ms) 224.58 ± 61.57 221.57 ± 53.44 0.916 Tricuspid E/A 0.94 (0.85–1.31) 1.08 (0.92–1.35) 0.655 Mitral S′ velocity (cm/s) 7.08 ± 1.93 7.05 ± 1.07 0.950 Mitral E′ velocity (cm/s) 5.62 ± 2.05 6.25 ± 1.39 0.326 Mitral A′ velocity (cm/s) 7.47 ± 2.51 9.09 ± 1.73 0.041 Mitral E′/A′ 0.71 (0.50–1.00) 0.69 (0.60–0.87) 0.967 Mıtral E/E′ 15.96 ± 7.51 11.02 ± 2.79 0.032 Apical 4C longitudinal strain (%) –14.36 ± 3.21 –16.94 ± 1.64 < 0.001 Apical 2C longitudinal strain (%) –15.10 (–16.80 to –12.30) –17.10 (–17.80 to –16.00) 0.001 Apical 3C longitudinal strain (%) –14.33 ± 3.77 –16.30 ± 1.49 0.003 Global longitudinal strain (%) –14.52 ± 3.01 –16.85 ± 1.36 < 0.001 ALPM strain (%) –14.00 (–22 to –11) –23.00 (–24.99 to –19.01) 0.016 AL peak straın 0.33 ± 0.13 0.44 ± 0.11 0.010 PMPM strain (%) –15.5 (–24.02 to –10.16) –22.30 (–26.48 to –15.95) 0.010 PM peak strain 0.34 ± 0.12 0.45 ± 0.09 0.007 SBP: systolic blood pressure, DBP: diastolic blood pressure, HR: heart rate, IVS: interventricular septum, PW: posterior wall, LVMI: left ventricular mass index, LVEDD: left ventricular end-diastolic diameter, LVESD: left ventricular endsystolic diameter, LAAP: left atrial anteroposterior diameter, TAPSE: tricuspid annular systolic excursion, DT: deceleration time, MPI: myocardial performance index, ALPM: anterolateral papillary muscle, PMPM: posteromedial papillary muscle.
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