PS-C14-9: DIFFERENTIAL DIAGNOSIS OF HYPERTROPHIC CARDIOMYOPATHY AND HYPERTENSIVE HEART DISEASE

Abstract

Objective: To conduct a differential diagnosis of hypertrophic cardiomyopathy and hypertensive heart. Material and Methods: The study included 40 patients with hypertrophic cardiomyopathy without left ventricle outflow tract obstruction, mean age 57.3 ± 9.5 years, 26 women and 30 patients with hypertensive heart, mean age 49.0 ± 8.7 years, 21 men. Results: The diagnosis of hypertrophic cardiomyopathy was established on the basis of clinical and anamnestic data, electrocardiography and echocardiography, genetics, upon detection of left ventricle myocardial hypertrophy with a maximum wall thickness of > 15 mm without dilatation of its cavity in the absence of other heart diseases. Hypertensive heart was diagnosed in patients with left ventricle myocardial hypertrophy > 12 mm due to hypertension. Hypertonic disease was detected according to the data of 24 hour blood pressure monitoring when systolic blood pressure > 135 mm Hg was recorded during wakefulness, diastolic > 85 mm Hg. The patients of both groups were comparable in terms of gender and age. Left ventricle myocardial mass index, interventricular septum thickness in diastole in patients with hypertrophic cardiomyopathy significantly exceeded those in patients with hypertensive heart. The thickness of the posterior wall of the left ventricle was almost the same in both groups. The maximum pressure gradient in hypertrophic cardiomyopathy at a load of 9 to 22 mm Hg. According to blood pressure monitoring data, arterial hypertension was detected in 65% of patients with hypertrophic cardiomyopathy. The degree of arterial hypertension was higher in patients with hypertensive heart. Exercise tolerance in patients with hypertension was higher than 111.0 ± 22.2. The maximum systolic blood pressure at the peak of physical activity in hypertrophic cardiomyopathy was significantly lower than in hypertensive heart 159.6 ± 21.1 and 196 ± 7.9 mmHg. Dyspnea as a reason for discontinuation of the test was more often observed in hypertrophic cardiomyopathy, 39% and 5%. In 26% of patients with hypertrophic cardiomyopathy, frequent ventricular extrasystole occurred at the height of the load, and no rhythm disturbances were recorded in patients with hypertensive heart. Conclusion: According to echocardiography data, there was no significant difference; systolic blood pressure at the height of the load in patients with hypertensive heart was significantly higher. Despite the above differences between patients with hypertrophic cardiomyopathy and hypertensive heart, it is not possible to single out an absolute sign that allows for a differential diagnosis. Important is the history of the disease, complaints and genetic analysis to identify mutations in hypertrophic cardiomyopathy.