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Left ventricular diastolic function assessed using Doppler tissue imaging in patients with hypertrophic
Y Matsumura1, P M Elliott, M S Virdee
1Department of Cardiological Sciences, St George's Hospital Medical School, London SW17, UK.
Insights
Diastolic mitral annular velocities are reduced in hypertrophic cardiomyopathy patients. The transmitral E to lateral Ea ratio, unlike conventional Doppler indices, correlates with functional class and exercise capacity.
Area of Science:
- Cardiology
- Echocardiography
- Diastolic Function
Background:
- Conventional Doppler indices for left ventricular diastolic function lack correlation with symptoms and exercise capacity in hypertrophic cardiomyopathy due to loading condition dependency.
- Diastolic mitral annular velocity, measured via Doppler tissue imaging, offers a preload-independent assessment of left ventricular diastolic function.
Purpose of the Study:
- To investigate the relationship between diastolic annular velocities, conventional Doppler indices, and clinical parameters (symptoms, exercise capacity) in hypertrophic cardiomyopathy.
- To evaluate the utility of diastolic annular velocities as a more reliable indicator of diastolic function in hypertrophic cardiomyopathy.
Main Methods:
- Studied 85 patients with hypertrophic cardiomyopathy and 60 healthy controls.
- Measured diastolic mitral annular velocities, transmitral left ventricular filling velocities, and pulmonary venous velocities using Doppler echocardiography.
Main Results:
- Early diastolic annular velocities (Ea) were significantly lower in hypertrophic cardiomyopathy patients compared to controls.
- The ratio of transmitral early filling velocity (E) to lateral Ea correlated inversely with peak oxygen consumption, unlike conventional Doppler indices alone.
- Higher E to lateral Ea ratios were observed in patients with more advanced New York Heart Association (NYHA) functional class.
Conclusions:
- Reduced early diastolic mitral annular velocities are characteristic of hypertrophic cardiomyopathy.
- The transmitral E to lateral Ea ratio demonstrates a stronger correlation with NYHA functional class and exercise capacity than conventional Doppler indices, suggesting its clinical utility in assessing diastolic dysfunction in hypertrophic cardiomyopathy.
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.