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Tissue Doppler imaging assessment of long axis left ventricular function in hypertrophic cardiomyopathy
Nuno Cardim1, Susana Castela, Rui Cordeiro
1Serviço de Cardiologia, Hospital Pulido Valente, Lisboa. corclinica@clix.pt
Insights
Tissue Doppler imaging reveals abnormal long axis systolic and diastolic function in hypertrophic cardiomyopathy (HCM) patients, even with normal global function. This highlights HCM
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Physiology
Background:
- Hypertrophic cardiomyopathy (HCM) is traditionally viewed as a diastolic dysfunction.
- Assessing long axis left ventricular (LV) function is crucial for global ventricular assessment but often complex.
- Tissue Doppler imaging (TDI) of the mitral annulus offers a method to study LV long axis function.
Purpose of the Study:
- To evaluate long axis systolic and diastolic function in non-obstructive hypertrophic cardiomyopathy using TDI.
- To compare TDI-derived parameters between HCM patients and healthy controls.
- To investigate heterogeneity and asynchrony in LV long axis function in HCM.
Main Methods:
- Pulsed TDI of the mitral annulus (septal, lateral, inferior, anterior) was performed in 47 HCM patients and 45 controls.
- Analysis included velocities, time intervals, and integrals for systolic (s) and diastolic (e, a) waves.
- Heterogeneity and asynchrony of long axis function were assessed and compared between groups.
Main Results:
- HCM patients exhibited reduced systolic velocities, prolonged systolic times, and increased systolic asynchrony despite normal global systolic function.
- Diastolic function was significantly impaired, with lower e and a wave velocities, prolonged protodiastolic times, and increased diastolic asynchrony.
- HCM patients showed higher prevalence of abnormal e/a ratios, particularly on the septal side.
Conclusions:
- TDI enables detailed analysis of LV long axis function in HCM.
- Long axis systolic and diastolic functions are significantly abnormal in HCM, extending beyond traditional diastolic dysfunction.
- Long axis dysfunction in HCM is complex, influenced by factors beyond regional hypertrophy.
Background:
Hypertrophic cardiomyopathy is classically defined as a diastolic disease with normal systolic function. Long axis left ventricular function is an important and sensitive determinant of global ventricular function but its assessment is often difficult and complex. Tissue Doppler imaging of the mitral annulus allows the study of long axis left ventricular function.
Methods:
47 patients with non-obstructive hypertrophic cardiomyopathy and 45 healthy volunteers, matched by age and sex, were studied with pulsed tissue Doppler imaging of the 4 sides of the mitral annulus (septal, lateral, inferior, anterior) in 4 and 2 chamber views. In each wave (systolic-s, rapid filling-e, atrial contraction-a) we analyzed velocities, time intervals and velocity-time integrals, as well as heterogeneity and asynchrony. Data were compared among the different sides in each group, between groups and with conventional Doppler data.
Results:
In contrast to normal subjects, hypertrophic cardiomyopathy patients showed: 1--Systolic function: lower velocities, longer systolic time intervals (isovolumic relaxation time, time to peak s, ejection time), higher systolic asynchrony (time to peak s, ejection time, systolic time) and lower s/shortening fraction ratio. These changes occurred despite normal indices of global systolic function. 2--Diastolic function: lower velocities (much lower rapid filling velocity, lower atrial contraction velocity, lower septal e/a), higher e/a heterogeneity index, longer protodiastolic times (isovolumic relaxation time and time to peak e), higher diastolic asynchrony (time to peak e) and lower e wave integral. Hypertrophic cardiomyopathy patients also showed higher average number of annular sides with e/a < 1 per patient and higher percentage of e/a < 1, mainly on the septal side.
Conclusions:
This study shows that: 1--Tissue Doppler imaging allows the detailed analysis of long axis left ventricular function in hypertrophic cardiomyopathy patients. 2--Long axis systolic function is abnormal in this disease, even in the presence of normal indices of global systolic function. 3--Long axis diastolic function is deeply disturbed in hypertrophic cardiomyopathy, at ventricular and atrial levels. 4--Long axis dysfunction occurs in annular sides contiguous to hypertrophied and non-hypertrophied walls, highlighting the role of other factors in its pathophysiology.
