Abstract
AimsNot all obstructive hypertrophic cardiomyopathy (HCM) patients are symptomatic. The relation between obstructive HCM and symptoms is not well understood. The hypothesis of this study is that left-ventricular outflow tract (LVOT) acceleration time (AT) is associated with symptoms.MethodsWe included 187 patients (61% men, mean age 55 ± 14 years) with obstructive HCM, defined as a maximal wall thickness ≥ 15 mm and a resting or provoked LVOT peak gradient ≥ 30 mmHg. Peak velocity (PV), left-ventricular (LV) ejection time (ET), and AT (the time between LVOT flow onset and the moment of PV) were measured on continuous-wave (CW) Doppler tracings. Logistic and Cox proportional hazard regression analyses were used to evaluate the relation between symptoms [New York Heart Association (NYHA) class ≥ II] and echocardiographic measurements, including AT. Reproducibility was assessed using the intraclass correlation coefficient (ICC).ResultsSymptomatic patients were more often female and had higher mean AT values. Logistic regression demonstrated a significant association between AT and symptomatic status (odds ratio 1.31 per 10 ms, p < 0.01) after adjustment for sex, negative inotropes, PV, LVOT diameter, and diastolic dysfunction. AT was independently associated with symptoms and septal reduction during follow-up (hazard ratio 1.09 per 10 ms, p < 0.05). The ICC was 0.98 with a mean difference of 0.28 ± 8.4 ms.ConclusionIn obstructive HCM patients, increased AT is significantly related to symptoms after adjustment for sex, negative inotropes, PV, LVOT diameter, and diastolic dysfunction, and is associated with the symptomatic status during follow-up. AT represents an easily measured echocardiographic variable with excellent inter-reader reproducibility.
Highlights
Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disease, with a prevalence of 0.2–0.5% of the general population [1]
A potential explanation lies in the assessment of acceleration time (AT), defined as the interval between the onset of ejection flow and the peak velocity (PV), which has been tested in a variety of clinical settings [4,5,6,7,8,9]
The LV systolic function was broadly similar among the groups, but the diastolic function was more commonly affected in the symptomatic group
Summary
Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disease, with a prevalence of 0.2–0.5% of the general population [1]. HCM patients are at increased risk of cardiac mortality and morbidity, those who exhibit left-ventricular outflow tract (LVOT) obstruction [2]. Previous studies have demonstrated that up to 70% of HCM patients have resting or provocable LVOT obstruction [3]. The relation between the magnitude of LVOT obstruction and the presence of symptoms is not well defined, and both asymptomatic patients with severe obstruction and symptomatic patients with only mild obstruction are commonly encountered in clinical practice. Previous studies in patients with aortic stenosis (AS) have demonstrated that an increase in stenosis severity leads to increased AT [4,5,6,7]. The aim of this study is to assess the relation between clinical characteristics and echocardiographic measurements, including AT and symptoms in obstructive HCM patients
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