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Influence of dynamic obstruction and hypertrophy location on diastolic function in hypertrophic cardiomyopathy

Gustavo Avegliano1, J Pablo Costabel, Marina Huguet

  • 1aCardiac Imaging Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina bCenter for Computational Imaging and Simulation Technologies in Biomedicine, Universitat Pompeu Fabra cCetir Sant Jordi dCentro Cardiovascular Sant Jordi eInstitució Catalana de Recerca i Estudis Avançats, Barcelona, Spain.

Journal of Cardiovascular Medicine (Hagerstown, Md.)
|March 26, 2014
PubMed

Insights

Hypertrophic cardiomyopathy (HCM) subtypes show distinct diastolic dysfunction. Obstructive asymmetric septal HCM has greater impairment than nonobstructive septal and apical forms, impacting clinical outcomes.

Area of Science:

  • Cardiology
  • Echocardiography
  • Cardiovascular Imaging

Background:

  • Hypertrophic cardiomyopathy (HCM) presents significant genetic and phenotypic variability.
  • Obstructive septal forms of HCM are associated with poorer clinical outcomes compared to nonobstructive septal and apical variants.

Purpose of the Study:

  • To investigate differences in left ventricular diastolic function across various HCM subgroups.
  • To evaluate how hypertrophy location and dynamic obstruction influence diastolic dysfunction and clinical status.

Main Methods:

  • Eighty-six patients with HCM were analyzed, categorized into obstructive asymmetric septal (OAS), nonobstructive asymmetric septal (NOAS), and apical (ApHCM) types.
  • Conventional and tissue Doppler echocardiography assessed diastolic function per latest guidelines.
  • Cardiac magnetic resonance quantified left ventricular mass and analyzed morphologic subtypes.

Main Results:

  • Early diastolic annular velocity (e') was significantly lower in OAS (5 cm/s) versus NOAS (7 cm/s) and ApHCM (7.5 cm/s).
  • The E/e' ratio was highest in OAS (14), followed by NOAS (10) and ApHCM (8.5).
  • No significant differences in left ventricular mass or maximal wall thickness were observed between groups.

Conclusions:

  • The location of left ventricular hypertrophy and dynamic obstruction significantly impact diastolic dysfunction severity in HCM.
  • Obstructive asymmetric septal HCM exhibits greater diastolic impairment, while apical involvement shows markedly less dysfunction.
Abstract

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