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Noninvasive detection of left ventricular diastolic dysfunction using M-mode echocardiography to assess left
Insights
This study introduces three M-mode echocardiography patterns of left ventricular (LV) posterior wall motion to assess diastolic dysfunction in hypertrophic cardiomyopathy (HC). These patterns correlate with increased LV end-diastolic pressure and impaired LV pressure reduction.
Area of Science:
- Cardiology
- Echocardiography
- Cardiovascular Physiology
Background:
- Assessing left ventricular (LV) diastolic dysfunction severity in hypertrophic cardiomyopathy (HC) is clinically challenging.
- Existing methods may not fully capture the nuances of diastolic dysfunction in HC patients.
Purpose of the Study:
- To propose and validate a novel, noninvasive index for quantifying LV diastolic dysfunction severity in HC using M-mode echocardiography.
- To correlate specific LV posterior wall motion patterns with hemodynamic parameters of diastolic function.
Main Methods:
- Prospective M-mode echocardiography recording in 35 HC patients.
- Classification of LV posterior wall motion into three patterns: normal, flat, and downward motion.
- Comparison of echocardiographic patterns with LV systolic function, LV filling indices, LV end-diastolic pressure, and LV pressure reduction parameters.
Main Results:
- No significant differences in hypertrophy characteristics or LV systolic function were observed across the three motion patterns.
- Patients with flat and downward motion patterns exhibited increased LV end-diastolic pressure compared to normal motion.
- A stepwise deterioration in the maximal rate of LV pressure decrease and an increase in the time constant of LV pressure reduction were noted from normal to flat to downward motion patterns.
Conclusions:
- M-mode echocardiography-derived LV posterior wall motion patterns offer a valuable, noninvasive method to assess LV diastolic dysfunction severity in HC.
- These patterns are associated with worsening diastolic function parameters, including elevated LV end-diastolic pressure and prolonged LV pressure relaxation.
Abstract:
In patients with hypertrophic cardiomyopathy (HC), it is difficult to determine the severity of left ventricular (LV) diastolic dysfunction. Three different patterns of LV posterior wall motion were found by M-mode echocardiography in patients with HC, and the use of these patterns is proposed as a new noninvasive index of the severity of LV diastolic dysfunction. M-mode echocardiograms were recorded prospectively from 35 patients with HC, and the posterior wall motion pattern in late systole and early diastole was classified into the following 3 types: (1) normal motion (n = 9); (2) flat motion--flat motion from late systole to early diastole, followed by rapid backward movement (n = 13); and (3) downward motion--slow backward movement from late systole (n = 13). There were no differences in the severity or type of hypertrophy, LV systolic function and pulsed Doppler indexes of LV filling among these 3 groups. However, LV end-diastolic pressure was increased in the groups with flat (15 +/- 6 mm Hg) and downward (16 +/- 9 mm Hg) motion. Furthermore, the maximal rate of decrease in LV pressure (normal 1,450 +/- 300, flat 1,250 +/- 300 and downward 860 +/- 80 mm Hg/s) and the time constant of LV pressure reduction (normal 60 +/- 15, flat 70 +/- 25 and downward 101 +/- 34 ms) showed a stepwise deterioration from the normal to the flat and then to the downward motion groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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