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How does morphology impact on diastolic function in hypertrophic cardiomyopathy? A single centre experience
Gherardo Finocchiaro1, Francois Haddad2, Aleksandra Pavlovic1
1Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
Insights
In hypertrophic cardiomyopathy (HCM), diastolic dysfunction is consistently present across all morphological patterns. Left ventricular obstruction, age, hypertrophy, and mitral regurgitation are key factors influencing diastolic dysfunction in HCM patients.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Heart Failure Research
Background:
- Hypertrophic cardiomyopathy (HCM) is a complex condition affecting heart muscle structure.
- The impact of specific HCM morphologies on diastolic function remains incompletely understood.
- Diastolic dysfunction is a common complication in HCM, affecting patient prognosis.
Purpose of the Study:
- To investigate the relationship between diverse HCM morphologies and diastolic function parameters.
- To identify key clinical and echocardiographic correlates of diastolic dysfunction in a large HCM cohort.
- To determine if specific HCM patterns are associated with more severe diastolic impairment.
Main Methods:
- Retrospective analysis of 383 HCM patients with preserved systolic function.
- Classification of HCM morphology into predefined categories (reverse, sigmoid, symmetric, apical, undefined).
- Comprehensive echocardiographic assessment of diastolic function (E', E/E', indexed left atrial volume) compared to 100 healthy controls.
Main Results:
- No significant differences in diastolic dysfunction parameters (E', E/E', LAVi) were observed among different HCM morphologies.
- All HCM morphologies demonstrated impaired diastolic function compared to controls.
- Left ventricular (LV) obstruction was a significant independent predictor of diastolic dysfunction, particularly elevated LAVi, E/E', and reduced E'.
Conclusions:
- Diastolic dysfunction in HCM is prevalent across all morphological types and not significantly influenced by the specific pattern.
- Key independent predictors of diastolic dysfunction include LV obstruction, patient age, LV wall thickness, and mitral regurgitation severity.
- These findings highlight the importance of addressing LV obstruction and other contributing factors to manage diastolic dysfunction in HCM.
Objectives:
It is unclear if morphology impacts on diastole in hypertrophic cardiomyopathy (HCM). We sought to determine the relationship between various parameters of diastolic function and morphology in a large HCM cohort.
Setting:
Tertiary referral centre from Stanford, California, USA.
Partecipants:
383 patients with HCM and normal systolic function between 1999 and 2011. A group of 100 prospectively recruited age-matched and sex-matched healthy participants were used as controls.
Primary And Secondary Outcome Measures:
Echocardiograms were assessed by two blinded board-certified cardiologists. HCM morphology was classified as described in the literature (reverse, sigmoid, symmetric, apical and undefined).
Results:
Reverse curvature morphology was most commonly observed (218 (57%). Lateral mitral annular E'<12 cm/s was present in 86% of reverse, 88% of sigmoid, 79% of symmetric, 86% of apical and 81% of undefined morphology, p=0.65. E/E' was similarly elevated (E/E': 12.3±7.9 in reverse curvature, 12.1±6.1 in sigmoid, 12.7±9.5 in symmetric, 9.4±4.0 in apical, 12.7±7.9 in undefined morphology, p=0.71) and indexed left atrial volume (LAVi)>40 mL/m(2) was present in 47% in reverse curvature, 33% in sigmoid, 32% in symmetric, 37% in apical and 32% in undefined, p=0.09. Each morphology showed altered parameters of diastolic function when compared with the control population. Left ventricular (LV) obstruction was independently associated with all three diastolic parameters considered, in particular with LAVi>40 mL/m(2) (OR 2.04 (95% CI 1.23 to 3.39), p=0.005), E/E'>15 (OR 4.66 (95% CI 2.51 to 8.64), p<0.001) and E'<8 (OR 2.55 (95% CI 1.42 to 4.53), p=0.001). Other correlates of diastolic dysfunction were age, LV wall thickness and moderate-to-severe mitral regurgitation.
Conclusions:
In HCM, diastolic dysfunction is present to similar degrees independently from the morphological pattern. The main correlates of diastolic dysfunction are LV obstruction, age, degree of hypertrophy and degree of mitral regurgitation.
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