CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 3, July/August 2023 172 AFRICA significant correlation with GLS (r = 0.459, p = 0.004), IVS thickness (r = 0.319, p = 0.045) and LAAP (r = 0.430, p = 0.018) (Table 3). Figs 3 and 4 show a correlation of ALPM and PMPM with IVS thickness, respectively. In order to determine the cut-off values of GLS, and ALPM and PMPM strain, ROC curve analysis was done. A GLS value of –13.05 had a sensitivity of 61.9% and specificity of 97.4% for predicting HCMP. ALPM and PMPM free strain values of –15.31 and –17.17% had 63 and 76.9% sensitivity and 85.7 and 76.9% specificity for prediction of HCMP. Table 4 and Fig. 5 show the ROC curve analysis for predicting HCMP. The intraclass correlation coefficient of two echocardiographic measurements was found to be 0.837 (95% confidence interval: 0.635–0.926), indicating a good agreement between the two measurements. Discussion Our study showed that, in addition to GLS, papillary muscle free strain was reduced in HCMP, implying functional abnormality in the papillary muscle. The papillary muscle free strain reduction was greater in the HCMP patients than in the HT patients and had a predictive value in distinguishing HCMP from HT. Other echocardiographic parameters that were helpful in differentiating HCMP from HT were IVS thickness, LVEDD, LVESD, LVMI, IVS/PW, LAAP diameter and mitral E/E′ ratio. The differential diagnosis of HT hypertrophy from HCMP hypertrophy can be cumbersome. Histologically, myocyte hyperplasia and interstitial fibrosis are predominant findings in HT hypertrophy, whereas HCMP hypertrophy is linked with myocyte disarray and fibrosis that is unproportional to the hypertrophy.12,13 The amount of fibrosis, regardless of its cause, can be used for risk stratification of patients.14 Echocardiography is usually the first imaging method used for evaluating patients with LVH. Generally concentric hypertrophy Simple error bar: mean of GLS, ALPA strain, PMPM strain Mean HCMP group HT group Group Error bars: 95% CI 0.00 –10.00 –20.00 –30.00 GLS ALPM strain PMPM strain GLS ALPM strain PMPM strain Fig. 2. GLS, ALPM and PMPM free strain of the two groups. Table 2. Correlation of ALPM with other parameters Variables r p-value Global longitudinal strain 0.604 < 0.001 Maximal wall thickness 0.407 0.032 IVS thickness 0.425 0.006 LVMI 0.465 0.002 LVEDD –0.135 0.399 LVESD 0.008 0.958 LAAP 0.277 0.131 Mitral S′ velocity –0.172 0.317 IVS: interventricular septum, LVMI: left ventricular mass index, LVEDD: left ventricular end-diastolic diameter, LVESD: left ventricular end-systolic diameter, LAAP: left atrial anteroposterior diameter. Table 3. Correlation of PMPM with other parameters Variables r p-value Global longitudinal strain 0.459 0.004 Maximal wall thickness 0.071 0.725 IVS thickness 0.319 0.045 LVMI 0.135 0.405 LVEDD –0.048 0.767 LVESD 0.052 0.752 LAAP 0.430 0.018 Mitral S′ velocity –0.057 0.743 IVS: interventricular septum, LVMI: left ventricular mass index, LVEDD: left ventricular end-diastolic diameter, LVESD: left ventricular end-systolic diameter, LAAP: left atrial anteroposterior diameter. ALPM strain IVS thickness –35.00 –30.00 –25.00 –20.00 –15.00 –10.00 –5.00 4.00 3.00 2.00 1.00 Fig. 3. Correlation of ALPM free strain with IVS thickness. PMPM strain IVS thickness –40.00 –20.00 0.00 20.00 4.00 3.00 2.00 1.00 R2 linear = 0,075 Fig. 4. Correlation of PMPM free strain with IVS thickness.
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