Left ventricular diastolic function assessed using Doppler tissue imaging in patients with hypertrophic cardiomyopathy: relation to symptoms and exercise capacity

• Published in: British heart journal 2002-03, Vol.87 (3), p.247-251
• Main Authors: Matsumura, Y, Elliott, P M, Virdee, M S, Sorajja, P, Doi, Y, McKenna, W J
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age; Aged; Analysis; Biological and medical sciences; Blood Flow Velocity; Cardiology. Vascular system; Cardiomyopathy; Cardiomyopathy, Hypertrophic - diagnostic imaging; Cardiomyopathy, Hypertrophic - physiopathology; Cardiovascular Medicine; Child; Clinical outcomes; Cohort Studies; Diastole (Cardiac cycle); Diastole - physiology; Doppler echocardiography; Doppler effect; Doppler tissue imaging; early diastolic velocity of mitral annulus; Echocardiography, Doppler - methods; Electrocardiography; Exercise - physiology; Exercise Test; Female; Flow velocity; Heart; Heart attacks; Humans; hypertrophic cardiomyopathy; late diastolic velocity of mitral annulus; Male; Medical sciences; Middle Aged; mitral annular velocity; Myocarditis. Cardiomyopathies; Oxygen Consumption - physiology; Studies; transmitral early left ventricular filling velocity; transmitral late left ventricular filling velocity; Variance analysis; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - physiopathology; Ventricular Function, Left - physiology
• ISSN: 1355-6037; 0007-0769; 1468-201X
• DOI: 10.1136/heart.87.3.247

Background: Conventional Doppler indices of left ventricular diastolic function do not correlate with symptoms or exercise capacity in patients with hypertrophic cardiomyopathy, because of their dependence on loading conditions. Diastolic mitral annular velocity measured using Doppler tissue imaging has been reported to be a preload independent index of left ventricular diastolic function. Objective: To determine the relation between diastolic annular velocities combined with conventional Doppler indices and symptoms or exercise capacity in hypertrophic cardiomyopathy. Methods: 85 patients with hypertrophic cardiomyopathy and 60 normal controls were studied. Diastolic mitral annular velocities, transmitral left ventricular filling, and pulmonary venous velocities were measured. Results: Early diastolic velocities at lateral and septal annulus were lower in patients with hypertrophic cardiomyopathy than in controls (lateral Ea: 10 (3) v 18 (4) cm/s, p < 0.0001; septal Ea: 7 (2) v 12 (3) cm/s, p < 0.0001). Unlike conventional Doppler indices alone, transmitral early left ventricular filling velocity (E) to lateral Ea ratio correlated inversely with peak oxygen consumption (r = −0.42, p < 0.0001). Patients in New York Heart Association (NYHA) class III had a higher transmitral E to lateral Ea ratio (12.0 (4.6)) than those in NYHA class II (7.6 (3.1), p < 0.005) or class I (6.6 (2.6), p < 0.0001). Conclusions: Early diastolic mitral annular velocities are reduced in patients with hypertrophic cardiomyopathy. Unlike conventional Doppler indices alone, the transmitral E to lateral Ea ratio correlates with NYHA functional class and exercise capacity.