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Objective·To analyze the differences and classify hypertrophic cardiomyopathy(HCM)patients and healthy controls(HC)using short-axis cine cardiac magnetic resonance(CMR)images-derived radiomics features.Methods·One hundred HCM subjects were included,and fifty HC were randomly selected at 2∶1 ratio during January 2018 to December 2021 in the Department of Cardiology,Renji Hospital,Shanghai Jiao Tong University School of Medicine.The CMR examinations were performed by experienced radiologists on these subjects.CVI 42 post-processing software was used to obtain left ventricular morphology and function measurements,including left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV)and left ventricular end-diastolic mass(LVEDM).The 3D radiomic features of the end-diastolic myocardial region were extracted from short-axis images CMR cine.The distribution of the radiomic features in the two groups was analysed and machine learning models were constructed to classify the two groups.Results·One hundred and seven 3D radiomic features were selected and extracted.After exclusion of highly correlated features,least absolute shrinkage and selection operator(LASSO)was used,and a 5-fold cross-validation was performed.There were still 11 characteristics with non-zero coefficients.The K-best method was used to decide the top 8 features for subsequent analysis.Among them,four features were significantly different between the two groups(all P<0.05).Support vector machine(SVM)and random forest(RF)models were constructed to discriminate the two groups.The results showed that the maximum area under the curve(AUC)for the single-feature model(first order grayscale:entropy)was 0.833(95%CI 0.685?0.968)and the maximum accuracy for the multi-feature model was 83.3%with an AUC of 0.882(95%CI 0.705?0.980).Conclusion·There are significant differences in both left ventricular function and left ventricular morphology between HCM and HC.The 3D myocardial radiomic features of the two groups are also significantly different.Although single feature is able to distinguish the two groups,the combination of multi-features show better classification performance.
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Objective: To assess left ventricular torsion function and systolic synchronization in children with hypertrophic cardiomyopathy (HCM) by using two-dimensional speckle tracking echocardiography (2D-STI), so as to provide theoretical basis for early clinical evaluation of cardiac function in children. Methods: Twenty-nine children with HCM in Shanghai Children’s Hospital, Shanghai Jiao Tong University from October 2018 to March 2019 were divided into two groups according to whether having clinical symptoms, i.e., asymptomatic HCM group (n=17) and symptomatic HCM group (n=12). Thirty normal children were also enrolled in the normal control group. All subjects underwent echocardiography, and the torsion-and strain-related data of the whole and different myocardial segments in the cardiac sections of left ventricle were obtained by 2D-STI. Results: Left ventricular strain analysis showed that the left ventricular longitudinal strains of both HCM groups decreased significantly compared with the normal control group (P<0.05), while the radial and circumferential strains increased significantly (P<0.05). The maximum difference of peak time in different segments on six cardiac sections in the symptomatic HCM group was significantly higher than that in the normal control group (P=0.000), while the difference between the asymptomatic HCM group and the normal control group was not significant. Left ventricular torsion function analysis showed that the global peak twists of left ventricle and positive peaks of rotation velocity in both HCM groups were significantly higher compared with the normal control group (P<0.05), standardized times to peak were longer (P<0.05), and negative peaks of rotation velocity and the untwisting rates were lower (P<0.05). Conclusion: In the children with HCM, the left ventricular torsion function is enhanced and diastolic function is weakened. In the symptomatic children, the left ventricular systolic synchrony is poor.
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The transthoracic echocardiography(TTE)plays a critical role in the diagnosis and evaluation of pediatric hypertrophic cardiomyopathy(HCM),and is currently recognized as the first choice in investigation of HCM. Comprehensive TTE is recommended in all children suspected with HCM. To meet the criteria of diagnosis of HCM,the left ventricular wall thickness at any or more segments of left ventricular myocardium should be greater than the predicted mean plus two standard deviations. In the meanwhile,other diseases,such as hypertension,valvular diseases and aortic diseases,which could contribute to increased cardiac load,should be excluded. Besides the measurement of the thickness of the hypertrophic ventricular wall,we should also pay attention to the description of myocardial morphology,myocardial echo intensity,uniformity,and outflow tract obstruction. It is also necessary to assess ventricular size and general systolic and diastolic function,and apply advanced techniques to evaluate myocardial function in order to fully assess the state of the disease or to make differential diagnosis. In addition,echocardiography also has a wide range of application prospects in the treatment of HCM.
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Hypertrophic cardiomyopathy (HCM) is a complex cardiovascular disorder with autosomal dominant inheritance, having an incidence of 0.1-0.5% in pregnant females. Anesthetic management of female with HCM posted for caesarean section is a challenge, as even minor alteration in hemodynamic status during the perioperative period may endanger the life of the patient. Here we report successful management of one patient with HCM for LSCS using epidural anaesthesia.