Basal Interventricular Septum Research Articles

Magnetic resonance imaging abnormalities in the basal interventricular septum of patients with left ventricular outflow tract arrhythmias.

Concealed structural abnormalities were detected by delayed enhancement - magnetic resonance imaging (DE-MRI) in patientswith apparently idiopathic tachycardia of left ventricular (LV) origin. Basal septal fibrosis was evaluated as a potential arrhythmia substrate in patients with left ventricular outflow tract (LVOT) arrhythmias. A total of 22 patients with LVOT arrhythmias, including frequent monomorphic premature ventricular complexes (PVCs) in 15 patients and ventricular tachycardia (VT) in 7 patients, underwent catheter ablation and DE-MRI. A total of 19 patients with frequent PVCs and 17 patients with idiopathic VT of other origin served as a control group. Basal septal intramural fibrosis as thin strip-shaped intramyocardial DE or as marked intramyocardial DE involving >25% of wall thickness was detected more frequently in patients with LVOT arrhythmias (41% and 32%) than in patients with non LVOT arrhythmias (14% and 3%). After successful ablation, 4/16 patients with basal septal intramural fibrosis and LVOT PVCs (n = 3) or LVOT VT (n = 1) compared with no patient without basal septal fibrosis experienced episodes of sustained VT with similar or different QRS morphology resulting in ICD therapy in three patients. Follow-up DE-MRI after PVC ablation (17 ± 7 months) revealed an increase in LV ejection fraction from 49 ± 5% to 56 ± 5% (n = 9) but the amount of septal DE remained unchanged. Basal septal intramural fibrosis may serve as the arrhythmia substrate in a substantial part of patients with premature ventricular complexes (PVCs) and VT originating from the LVOT and identifies patients with continued risk for VT recurrence after initially successful ablation of LVOT arrhythmias.

Mitral Annulus Calcium Score

Background: The risk of conduction system abnormalities (CSA) after transcatheter aortic valve implantation remains high. We aimed to evaluate the impact of mitral annular calcium (MAC) score on th...

A 30-day drastic thinning of the basal interventricular septum in isolated cardiac sarcoidosis masquerading as a hypertrophic cardiomyopathy.

A 30-day drastic thinning of the basal interventricular septum in isolated cardiac sarcoidosis masquerading as a hypertrophic cardiomyopathy.

Surgical as Opposed to Transcatheter Aortic Valve Replacement Improves Basal Interventricular Septal Hypertrophy

Basal interventricular septum (IVS) hypertrophy (BSH) with reduced basal IVS contraction and IVS-aorta angle is frequently associated with aortic stenosis (AS). BSH shape suggests compression by the longitudinally elongated ascending aorta, causing basal IVS thickening and contractile dysfunction, further suggesting the possibility of aortic wall shortening to improve the BSH. Surgical aortic valve replacement (SAVR), as opposed to transcatheter AVR (TAVR), includes aortic wall shortening by incision and stitching on the wall and may potentially improve BSH. We hypothesized that BSH configuration and its contraction improves after SAVR in patients with AS. Methods and Results: In 32 patients with SAVR and 36 with TAVR for AS, regional wall thickness and systolic contraction (longitudinal strain) of 18 left ventricular (LV) segments, and IVS-aorta angle were measured on echocardiography. After SAVR, basal IVS/average LV wall thickness ratio, basal IVS strain, and IVS-aorta angle significantly improved (1.11±0.24 to 1.06±0.17; -6.2±5.7 to -9.1±5.2%; 115±22 to 123±14°, P<0.001, respectively). Contractile improvement in basal IVS was correlated with pre-SAVR BSH (basal IVS/average LV wall thickness ratio or IVS-aorta angle: r=0.47 and 0.49, P<0.01, respectively). In contrast, BSH indices did not improve after TAVR. In patients with AS, SAVR as opposed to TAVR improves associated BSH and its functional impairment.

Characterization of the Electroanatomic Substrate in Cardiac Sarcoidosis: Correlation With Imaging Findings of Scar and Inflammation.

This study sought to characterize the electroanatomic (EAM) substrate in patients with cardiac sarcoidosis (CS) and ventricular tachycardia and its relationship to imaging findings of inflammation and fibrosis. CS is characterized by coexistence of active inflammation and replacement fibrosis. A total of 42 patients with CS based on established criteria and ventricular tachycardia underwent high-density EAM mapping. Abnormal electrograms (EGM) were collected and independently classified as multicomponentfractionated, isolated, late, and split according to standard criteria and regardless of the peak-to-peak bipolar/unipolar voltage. A total of 29 patients (69%) underwent pre-procedural cardiac magnetic resonance (CMR) and positron emission tomography (PET)/computed tomography (CT). The distribution of EAMsubstrate was correlated with regions of late gadolinium enhancement (LGE) on CMR and increased 18F-fluorodeoxyglucose uptake on PET/CT. Of 21,451 bipolar and unipolar EGM, 4,073 (19%) were classified as abnormal with a predominant distribution in the basal perivalvular segments and interventricular septum. Using the standard bipolar (<1.5 mV) and unipolar (<8.3mV for left ventricle<5.5 mV for the right) voltage cutoff values, 40% and 22% of the abnormal EGM were located outside the EAM low-voltage areas, respectively. LGE was present in 26 of 29 patients (90%), whereas abnormal 18F-fluorodeoxyglucose uptake in 14 of 29 patients (48%) with imaging. Segments with abnormal EGM had more LGE-evident scar transmurality [median: 24% (interquartile range [IQR]: 4% to 40%) vs. median: 5%(IQR: 0% to 15%); p< 0.001] and lower metabolic activity (median: 20 g glucose [IQR: 14 g to 30 g] vs. median: 29 g glucose [IQR: 18 g to 39 g]; p< 0.001). Overall, the agreement between the presence of abnormal EGM was higher with the presence of LGE (κ= 0.51; p< 0.001) than with the presence of active inflammation (κ=-0.12; p= 0.003). In patients with CS and ventricular tachycardia, pre-procedural imaging with CMR and PET/CT can be useful in detecting EAM abnormalities that are potential targets for substrate ablation. Abnormal EGM were more likelylocated in segments with more scar transmurality (LGE) at CMR and a lower degree of inflammation on PET.

O28-3 - A Case of Amyloid Cardiomyopathy Proved by Myocardial Biopsy but Diagnosed as Isolated Cardiac Sarcoidosis with Clinical Manifestations

A 74-year-old man with dyspnea on exertion was referred to our hospital for treatment of heart failure and evaluation of the cause. The symptom was immediately improved by medical therapy including oxygenation and diuretics. Electrocardiography showed frequent premature ventricular contraction with non-sustained ventricular tachycardia. Echocardiography revealed left ventricular (LV) dilatation (LV end-diastolic diameter/end-systolic diameter = 64/56 mm), thinning of the basal interventricular septum with severe hypokinesis of the region and LV systolic dysfunction (LVEF = 25%). Coronary angiography showed patent coronary artery. Late gadolinium enhancement in cardiac MR imaging was observed in septal to anterior wall. Furthermore, his lysozyme value was high (13.6 µg/mL). Cardiac sarcoidosis was strongly suspected, and 18F-fluorodeoxy glucose-positron emission tomography imaging showed lightly increased uptake in interventricular septum. Although he did not have the clinical findings other than heart, based on current guidelines for diagnosis and treatment of cardiac sarcoidosis (JCS 2016), a diagnosis of isolated cardiac sarcoidosis was finally made and we decided to start corticosteroid therapy with the initial dose of 30 mg/day of prednisolone. However, the specimens of myocardial biopsy revealed significant amount of transthyretin amyloid deposit. In addition 99mTc-pyrophosphate scintigraphy showed increased uptake by interventricular septum. In this case, there are two possibilities: first, all clinical manifestations due to transthyretin cardiac amyloidosis, and second, a chance complication with cardiac sarcoidosis and amyloid cardiomyopathy.

P1-5 - A Case of Cardiac Sarcoidosis With Difficulty of Steroid Therapy Due to Coexistence of Pulmonary Aspergillosis

A 76-year-old woman was admitted to our hospital with the chief complaint of dyspnea. Chest radiograph showed pulmonary congestion, and echocardiography revealed a decrease in LVEF of 47% with thinning of the basal interventricular septum. She was suspected to have cardiac sarcoidosis, and she was hospitalized to undergo detailed examinations. There were no coronary artery lesions with cardiac catheterization, and no abnormal findings in myocardial biopsy of the right ventricle. Gallium scintigraphy showed no abnormal uptake. Chest CT showed multiple granular shadows in bilateral lungs, and aspergilloma in the upper left lobe. Anti-fungal drug did not improve aspergillosis, and she had blood sputum. Left upper lobectomy was performed for this treatment. As the pathological findings revealed that she had two difficult lesion in the lung, aspergilloma and sarcoidosis. According to these findings, the heart lesion was diagnosed as cardiac sarcoidosis. In this case, because it was considered that introduction of steroid could result in relapse of pulmonary aspergillosis, she has not received steroid therapy. We report a case of cardiac sarcoidosis with difficulty to administer steroid therapy due to coexistence of pulmonary aspergillosis including literature considerations.

Hypertrophic Cardiomyopathy: Genetics, Pathogenesis, Clinical Manifestations, Diagnosis, and Therapy.

Hypertrophic cardiomyopathy (HCM) is a genetic disorder that is characterized by left ventricular hypertrophy unexplained by secondary causes and a nondilated left ventricle with preserved or increased ejection fraction. It is commonly asymmetrical with the most severe hypertrophy involving the basal interventricular septum. Left ventricular outflow tract obstruction is present at rest in about one third of the patients and can be provoked in another third. The histological features of HCM include myocyte hypertrophy and disarray, as well as interstitial fibrosis. The hypertrophy is also frequently associated with left ventricular diastolic dysfunction. In the majority of patients, HCM has a relatively benign course. However, HCM is also an important cause of sudden cardiac death, particularly in adolescents and young adults. Nonsustained ventricular tachycardia, syncope, a family history of sudden cardiac death, and severe cardiac hypertrophy are major risk factors for sudden cardiac death. This complication can usually be averted by implantation of a cardioverter-defibrillator in appropriate high-risk patients. Atrial fibrillation is also a common complication and is not well tolerated. Mutations in over a dozen genes encoding sarcomere-associated proteins cause HCM. MYH7 and MYBPC3, encoding β-myosin heavy chain and myosin-binding protein C, respectively, are the 2 most common genes involved, together accounting for ≈50% of the HCM families. In ≈40% of HCM patients, the causal genes remain to be identified. Mutations in genes responsible for storage diseases also cause a phenotype resembling HCM (genocopy or phenocopy). The routine applications of genetic testing and preclinical identification of family members represents an important advance. The genetic discoveries have enhanced understanding of the molecular pathogenesis of HCM and have stimulated efforts designed to identify new therapeutic agents.

Hypertrophic angulation deformity of the basal interventricular septum combined with abnormality of the papillary muscle and chordae tendineae

Case reportA Chinese woman was admitted to our hospital because of syncope. Transthoracic echocardiography revealed a hypertrophic basal interventricular septum of 15 mm with a sharp angle protruding into the left ventricular outflow tract. Moreover, an anomalous anterolateral papillary muscle (maximum width of 11 mm) was inserted into the left ventricular outflow tract, with short chordae tendineae connecting both basal interventricular septum and anterior leaflet of the mitral valve. All of these abnormalities resulted in a left ventricular outflow gradient of 136 mmHg. Surgical septal myectomy of the sharp angle combined with partial papillary muscle resection and removal of the abnormal chordae tendineae was selected to relieve the left ventricular outflow obstruction. This was a rare combination of deformity of the angulation of the focal basal interventricular septum and abnormalities of the papillary muscle and chordae tendineae, which led to left ventricular outflow obstruction.

Subclinical Decrease in Myocardial Function in Asymptomatic Infants of Diabetic Mothers: A Tissue Doppler Study

Infants of diabetic mothers (IDMs) with hypertrophic cardiomyopathy are recognized to have impaired myocardial performance, but less is known about ventricular function in IDMs without hypertrophy. We hypothesized that in asymptomatic newborns with normal two-dimensional echocardiographic evaluations, pulsed wave tissue Doppler imaging (TDI) would suggest a subclinical decrease in the cardiac function of IDMs compared to infants of non-diabetics (nIDMs). This is a retrospective cohort study of asymptomatic neonates ≥36weeks gestation, at 0-7 days of life, with normal standard echocardiograms. Systolic (S'), early diastolic (E'), and late diastolic (A') TDI velocities were measured at the mitral valve (MV) annulus, basal interventricular septum (IVS), and tricuspid valve (TV) annulus, and averaged from three consecutive cardiac cycles. Demographic, perinatal, and echocardiographic variables were compared between IDM and nIDM groups. Of 631 subjects, 75 IDMs were identified. The mean gestational age of the entire cohort was 39.33 weeks (±1.26), birth weight 3.44kg (±0.56), and body surface area (BSA) 0.21m2 (±0.02). IDMs had significantly greater birth weight and BSA, lower gestational age, older maternal age, and higher incidence of maternal obesity and hypertension than nIDMs (p < 0.001). On multivariable analysis, IDMs had significantly lower S' (p ≤ 0.03) and E' (p < 0.001) velocities, and higher E/E' ratios (p < 0.001) at the MV, IVS, and TV than nIDMs. In asymptomatic newborn IDMs without cardiac hypertrophy, pulsed wave TDI suggests a subclinical decrease in systolic and diastolic myocardial function compared to nIDMs.

Feasibility Assessment of Alcohol Septal Ablation in Transcatheter Aortic Valve Replacement Using Multidetector Computed Tomography

An 83-year-old man was referred for transcatheter aortic valve replacement (TAVR) for severe aortic stenosis. Preoperative 320–detector row multidetector computed tomography revealed aortic valve calcification and an asymmetrically thickened basal interventricular septum. Reconstruction of a

Characters of anatomy and flow dynamics of left ventricular outflow obstruction by echocardiography

Objective To observe the characters of anatomy and flow dynamics of left ventricular outflow obstruction(LVOTO) by echocardiography. Methods Echocardiographic date were analyzed in 159 patients with LVOTO.The thickness of the basal interventricular septum(IVST-b) and left ventricular posterior wall(LVPWT), the peak gradient of LVOT were measured. Systolic anterior motion of mitral valve( ) and the spectral profile in LVOT were recorded by continuous wave Doppler. Results One hundred and fifty-nine patients were divided into four groups: group A (hypertrophic obstructive cardiomyopathy, 69 cases), group B (hypertensive left ventricular hypertrophy, 60 cases), group C (senile thickening of the basal of interventricular septum, 19 cases) and group D (discrete subaortic membrane, 11 cases). IVST-b, IVST-b/ LVPWT and the peak gradient of flow in group A were significantly increased than those in group B and C (P<0.01). There was significant correlation between IVST-b, IVST-b/ LVPWT and the peak gradient of flow(r=0.56, 0.61, respectively, P<0.01) in group A+ B+ C. The CW character of LVOTO in group A, B and C was like the shape of Dagger , however, approximately equilateral triangle in group D. Conclusions The charicteristic spectral profile in LVOT can be used to differentiate pure mechanical obstruction from the dynamic obstruction or combined obstruction; IVST-b and SAM are the two important anatomical morphology factors in determination of the degree of dynamic obstruction. Key words: Echocardiography; Left ventricular outflow obstruction; Hemodynamics

Magnetic Resonance Imaging as a Predictor of Survival Free of Life-Threatening Arrhythmias and Transplantation in Cardiac Sarcoidosis.

BackgroundCardiac magnetic resonance imaging has a key role in today's diagnosis of cardiac sarcoidosis. We set out to investigate whether cardiac magnetic resonance imaging also helps predict outcome in cardiac sarcoidosis.Methods and ResultsOur work involved 59 patients with cardiac sarcoidosis (38 female, mean age 46±10 years) seen at our hospital since February 2004 and followed up after contrast‐enhanced cardiac magnetic resonance imaging. The extent of myocardial late gadolinium enhancement (measured as percentage of left ventricular mass), the volumes and ejection fractions of the left and right ventricles, and the thickness of the basal interventricular septum were determined and analyzed for prognostic significance. By April 2015, 23 patients had reached the study's end point, consisting of a composite of cardiac death (n=3), cardiac transplantation (n=1), and occurrence of life‐threatening ventricular tachyarrhythmias (n=19; ventricular fibrillation in 5 and sustained ventricular tachycardia in 14 patients). In univariate analysis, myocardial extent of late gadolinium enhancement predicted event‐free survival, as did scar‐like thinning (<4 mm) of the basal interventricular septum and the ejection fraction of the right ventricle (P<0.05 for all). In multivariate Cox regression analysis, extent of late gadolinium enhancement was the only independent predictor of outcome events on cardiac magnetic resonance imaging, with a hazard ratio of 2.22 per tertile (95% CI 1.07–4.59). An extent of late gadolinium enhancement >22% (third tertile) had positive and negative predictive values for serious cardiac events of 75% and 76%, respectively.ConclusionsFindings on cardiac magnetic resonance imaging and the extent of myocardial late gadolinium enhancement in particular help predict serious cardiac events in cardiac sarcoidosis.

Sigmoid septum: A variant of the ventricular hypertrophy or of the hypertrophic cardiomyopathy?

Sigmoid septum and hypertrophic cardiomyopathy presenting with left ventricular hypertrophy and, although they appear to be different entities, often involve problems in the differential diagnosis. This study was carried out to assess the prevalence and characteristics of the echocardiographic sigmoid septum and its differential findings regarding hypertrophic cardiomyopathy. Descriptive, observational and prospective study. A total of 1,770 patients were studied by echocardiography. Sigmoid septum (focal and isolated hypertrophy of the basal interventricular septum≥13mm in men and ≥12mm in women, exceeding ≥50% of the median septum thickness) was classified as «Type 1» (≤14mm) and «Type 2» (≥15mm). There were 59 cases of sigmoid septum (prevalence of 3.3%): 26 (1.5%) patients with type 1 (50% male) and 33 (1.9%) patients with type 2 (72.7% male); there were 25 (1.4%) cases of hypertrophic cardiomyopathy (76% male). The group with type 2 sigmoid septum differed from hypertrophic cardiomyopathy in: was older (73±10.5years; P<.0001), with more hypertension (84.8%; P<.0001), lower glomerular filtering (73.3±21.4ml/min; P=.007), lower repolarization abnormalities (18.2%; P=.004) and Cornell index (in men, 22.2±11mm; P=.041), more diastolic dysfunction (75%; P=.0089) and in ventricular morphology and fibrosis location in magnetic resonance. Regarding the hypertrophic cardiomyopathy, patients with type 2 sigmoid septum are older and generally hypertensive; otherwise, often they have no clear differences in their clinical, electrocardiographic or echocardiographic characteristics. Therefore, cardiac resonance is helpful in the differential diagnosis.

Parachute mitral valve and Pacman deformity of the ventricular septum in a middle-aged male

Parachute mitral valve and Pacman heart (incomplete muscular ventricular septal defect) are rare congenital deformities usually reported in infants and children. Very few adult patients with these anomalies are reported but the association of the two has not been described. This report describes a 56-year-old male with exertional dyspnea who was detected to have moderately severe mitral regurgitation and mitral stenosis. Typical parachute deformity of the mitral valve with a reduced opening and common attachment of all the chordae to a single posteromedial papillary muscle was evident. The chordae were elongated, lax, and redundant, which is atypical for this anomaly. Incidentally, detected aneurysm of the basal muscular interventricular septum (Pacman deformity or incomplete triangular septal defect) was also present.

Abstract 13596: Magnetic Resonance - Derived Pre-contrast T1 Relaxation Time is the Accurate Marker of Diffuse Myocardial Fibrosis in Severe Aortic Valve Disease: A Comparison With Left Ventricular Myocardial Biopsy

Introduction: Diffuse myocardial fibrosis (DFM) is the major mechanism in the pathophysiology of the aortic stenosis and its complications. DMF is detectable by magnetic resonance imaging (MRI) using the T1 mapping technique. Hypothesis: The MRI derived native T1 relaxation time and myocardial extracellular volume fraction (ECV) will be significantly related to the extent of DMF et targeted myocardial left ventricular (LV) biopsy. Methods: The study population consisted of 40 consecutive patients (age 63±8y, 65% males) undergoing surgery for severe aortic stenosis (77.5%), aortic root dilatation (7.5%) or valve regurgitation (15%). All patients underwent MRI-derived T1 mapping and 2D-, 3D speckle tracking-derived strain analysis prior to surgery. The T1 relaxation time was assessed in basal interventricular septum pre and 10 min post contrast administration using the modified Look-Locker Inversion recovery sequence. A LV myocardial biopsy specimen was obtained during surgery from basal interventricular septum under the guidance of the MRI operator to assure spatial concordance with the MRI assessment. The percentage of myocardial collagen was quantified as a ratio of Picrosirius Red-positive area over total sample area using the Image J. Results: The average percentage of myocardial collagen was 22 ± 14.8 %. The average native T1 relaxation time and ECV was 1010 ± 48 ms and 0.288 ± 0.055, respectively. Both native T1 relaxation time with cutoff value of ≥ 1010 ms (Ss=90%, Sp=73%, AUC =0.82) and ECV with cutoff value of ≥ 0.315 (Ss=80%, Sp=90%, AUC =0.85) showed high accuracy to identify extensive (&gt; 30%) myocardial collagen content (Figure 1A, 1B). The native T1 mapping showed significant correlation with LV mass, 2D and 3D global longitudinal strain (all p&lt;0.05) while the ECV did not (p=NS). Conclusions: Native T1 relaxation time is the accurate marker of diffuse myocardial fibrosis with the significant relationship with LV morphology and myocardial function.

GW26-e2282 Prevalence, clinical and echocardiography features of basal septal hypertrophy

Focal hypertrophy of the basal inter-ventricular septum is a well-recognized but poorly understood echocardiographic finding. The prevalence and clinical correlates of basal septal hypertrophy (BSH) has not been well investigated. We investigated the prevalence and clinical and echocardiography

Isolated Cardiac Involvement of Extranodal Rosai-Dorfman Disease: An Atypical Presentation

Rosai-Dorfman disease, also known as sinus histiocytosis with massive lymphadenopathy, an uncommon systemic histio-proliferative disease, characterized by the overproduction of histiocytes, which accumulate in lymph nodes throughout the body. The extranodal cardiac involvement of this disease was never reported so far. Clinical summary: 36 year old presented with history of class 2/4 dyspnoea of 2 year history with one episode of lymphocyte predominant pericardial effusion for which he had taken antitubercular therapy. Echocardiogram showed oval homogenous mass in the RVOT with severe PAH. CMR revealed infiltrating mass lesion in relation to the ventricular outflow tracts, the antero-superior walls of the left atrium and basal left ventricle, the anterior basal interventricular septum and the aorto-pulmonary window. Surgical excision of the tumour was done and histology showed of pin point hemorrhages showed spindle cells and fibrohistiocytic proliferation admixed with plasma cells lymphocytes & polymorphs. Histocytes were present in small clusters and singly with abundant pale cytoplasm and nuclei with vesicular chromatin. Phagocytosed neutrophils and lymphocytes were present in some of these cells (Emperipolesis). These were suggestive of lymphoproliferative disease consistent with Rosai-Dorfman Disease.

Fool Me Once, Fool Me Twice: Hypertrophic Cardiomyopathy with Aortic Stenosis

studies, including a complete blood count, basic metabolic panel, b-type natriuretic peptide level (35 pg/mL), and troponin level (0.01 ng/ML), were also unremarkable. Transthoracic echocardiography (TTE) revealed hyperdynamic left ventricular systolic function with an ejection fraction of 74% and asymmetric left ventricular hypertrophy. The aortic valve had 3 severely calcified cusps. In addition, the mitral valve exhibited severe systolic anterior motion, and the peak left ventricular outflow tract gradient was 64 mmHg. Mild posterolaterally-directed mitral valve regurgitation was evident. Transesophageal echocardiography (TEE) confirmed the presence of systolic anterior motion, a left ventricular outflow tract gradient of up to 65 mmHg, and asymmetric hypertrophy of the basal interventricular septum at 1.65 cm (Figure 1). The aortic valve area was 1.5 sq cm by planimetry.

The clinical and echocardiography features of basal septal hypertrophy

Objective To explore the prevalence and clinical and echocardiography features of the basal septal hypertrophy(BSH). Methods Clinical and echocardiography data of 1 056 elderly population in an urban community of Beijing were analyzed. BSH was defined as the thickness of basal interventricular septum ≥1.4 cm and basal septal/mid septal ≥1.3. Data were compared between BSH and non-BSH, and the risk factors of BSH were evaluated. Results The prevalence of BSH in this population was 7.39%(95%CI: 5.8%-9.0%). BSH was not associated with current cardiovascular diseases (P>0.05). Its correlates in logistic analysis included male, diabetes mellitus, small end diastolic left ventricular dimension and abnormal left ventricular diastolic function (P<0.05), with OR 0.49(0.29, 0.83), 1.99(1.18, 3.37), 2.24(1.35, 3.72), 0.39(0.26, 0.59), and 1.96(1.01, 3.81), respectively. Conclusions BSH is common in elderly community population and not associated with cardiovascular diseases. Its risk factors included male, obesity, diabetes mellitus, small end diastolic left ventricular dimension and abnormal left ventricular diastolic function. Key words: Echocardiography; Ventricular septum; Cardiomyopathies; Epidemiologic studies