Impaired Myocardial Function in Hypertrophic Cardiomyopathy

Abstract

Tissue Doppler imaging (TDI) parameters of peak myocardial velocities (S', E', and A') has been employed to assess the regional left ventricular myocardial function. The global function index (GFI) derived from TDI has been recently employed to distinguish the different etiologies of left ventricular hypertrophy. To analyze whether the GFI or individual TDI parameters of peak myocardial velocities (S', E', and A') allows detecting different degrees of regional myocardial dysfunction in the most frequent forms of hypertrophic cardiomyopathy (HCM). GFI = (E/E')/S' (where E is the peak transmitral flow velocity, E' is the early diastolic myocardial velocity, and S' is the peak systolic myocardial velocity) and TDI peak myocardial velocities was measured in the septal and lateral mitral annulus in 101 patients with HCM (mean age 47.5 +/- 14 years, 58 women) and in age-matched group of 30 healthy controls (mean age 46 +/- 6 years, 16 women). Forty-five patients had nonobstructive asymmetric septal HCM, 20 patients had a subaortic gradient >or= 30 mm Hg, 21 p. had apical HCM, and 15 p. had other forms of HCM (midventricular, symmetric, and biventricular). All patients with HCM exhibited a decrease in early diastolic (E') and systolic (S') myocardial velocities, both in the lateral and septal-mitral annulus border, but more pronounced in septal-mitral annulus. Septal GFI was higher in HCM patients than in healthy subjects (1.8 (1.1-2.5) and (0.57 (0.31-0.92), respectively, P < 0.001), but no differences were seen when different forms of HCM were compared. In a selected population of patients with HCM and a preserved left ventricular(LV) systolic function, GFI and individual TDI parameters of peak velocity (S', E', and A') and E/E' ratio were similar in different forms of HCM, indicating that in all patients with HCM there is regional systolic and diastolic myocardial dysfunction, regardless of the location of hypertrophy.