Doppler tissue imaging: regional myocardial function in hypertrophic cardiomyopathy and in athlete's heart
Nuno Cardim1, A Gouveia Oliveira, Susana Longo
1Department of Cardiology, Hospital Pulido Valente, Lisbon, Portugal. Corclinica@clix.pt
Insights
Doppler tissue imaging reveals distinct regional heart function differences between hypertrophic cardiomyopathy (HCM) patients and athletes. These findings aid in differentiating HCM from the athlete's heart, especially in ambiguous cases.
Area of Science:
- Cardiology
- Medical Imaging
- Sports Cardiology
Background:
- Differentiating hypertrophic cardiomyopathy (HCM) from the athlete's (AT) heart is clinically significant.
- Doppler tissue imaging (DTI) offers potential for analyzing regional myocardial function in differential diagnosis.
Purpose of the Study:
- To compare regional left ventricular (LV) function using DTI in patients with nonobstructive HCM and competitive rowers.
- To identify specific DTI parameters that distinguish between HCM and the athlete's heart.
Main Methods:
- Pulsed Doppler tissue imaging analyzed LV regional function in 24 HCM patients and 20 rowers.
- Evaluated longitudinal and radial myocardial mechanics, including velocities, time intervals, and gradients.
- Focused on parameters like precontraction period (PCP) and time to peak e velocity.
Main Results:
- HCM patients exhibited reduced systolic velocities and meridional gradients in both longitudinal and radial axes compared to athletes.
- Patients with HCM showed prolonged PCP and higher PCP/LV contraction time ratios.
- Diastolic function differences included lower e and a velocities, longer prerelaxation times, and a higher prevalence of e/a < 1 in HCM patients.
Conclusions:
- Significant systolic and diastolic regional LV function differences exist between HCM and athletes.
- These DTI-derived differences are observable in both longitudinal and radial axes, and even in non-hypertrophied segments.
- DTI is a valuable tool for the differential diagnosis of HCM and athlete's heart, particularly in challenging cases (Maron's 'grey zone').
Background:
The distinction between hypertrophic cardiomyopathy (HCM) and the athlete's (AT) heart is an important clinical problem, and the analysis of regional myocardial function with Doppler tissue imaging may be useful in the differential diagnosis.
Objective:
Our aim was to compare regional function assessed by Doppler tissue imaging in rowers and in a group of patients with HCM.
Methods:
In 24 patients with nonobstructive HCM and in 20 competitive rowers with similar age, blood pressure, and heart rate, we analyzed with pulsed Doppler tissue imaging left ventricular (LV) regional function (velocities, time intervals, heterogeneity and asynchrony indices, and meridional gradient) in the longitudinal (8 segments, apical views) and in the radial (2 segments, short-axis view) axis.
Results:
Compared with AT, patients with HCM showed: (1). systolic function; (a). longitudinal: lower velocities and meridional gradient; longer precontraction period (PCP); and higher PCP/LV contraction time; (b). radial: lower velocities and gradient; longer PCP; and higher PCP/LV contraction time; (2.diastolic function; (a). logitudinal: lower e (early diastolic), a (late diastolic), and e/a velocities; and longer prerelaxation time and time to peak e. The percentage of segments with e/a < 1 was 25% in the HCM group and 0% in the AT heart group; (b). radial: lower e velocity and gradient; lower e/a gradient; and longer medial prerelaxation and basal time to peak e. Most of these differences also occurred in the nonhypertrophied inferior wall of patients with HCM.
Conclusions:
There are significant differences between regional LV function of competitive rowers and patients with HCM. These differences (1). occur in systole and diastole; (2). affect velocities and time intervals; (3). are more striking in the long axis, but are also seen in the short axis, and (4). also occur in nonhypertrophied segments, suggesting the usefulness of the technique in the differential diagnosis between the 2 situations, namely in individuals that fall in Maron's "grey zone."
