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Aortic regurgitation associated with hypertrophic cardiomyopathy: a colour Doppler echocardiographic study
T Shiota1, T Sakamoto, K Takenaka
1Second Department of Internal Medicine, Faculty of Medicine, University of Tokyo, Japan.
Insights
Mild aortic regurgitation affects nearly a quarter of hypertrophic cardiomyopathy patients. This condition is linked to the left ventricular outflow tract
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Hypertrophic cardiomyopathy (HCM) is a complex cardiac condition.
- Aortic regurgitation (AR) is a potential complication, but its prevalence and cause in HCM are not fully understood.
Purpose of the Study:
- To assess the frequency, severity, and cause of aortic regurgitation in patients with hypertrophic cardiomyopathy.
- To compare findings in HCM patients with age-matched controls.
Main Methods:
- Utilized color Doppler and cross-sectional echocardiography.
- Evaluated 87 patients with HCM and 48 age-matched controls.
Main Results:
- Aortic regurgitation signals were detected in 23% of HCM patients versus 6% of controls.
- AR in HCM patients was associated with more prominent septal protrusion into the left ventricular outflow tract.
- No significant differences in age, blood pressure, aortic diameter, or valve calcification were found between HCM patients with and without AR.
Conclusions:
- Mild aortic regurgitation is common in hypertrophic cardiomyopathy.
- The morphological abnormalities of the left ventricular outflow tract are implicated in the development of AR in HCM.
Abstract:
The frequency, severity, and cause of aortic regurgitation were assessed by colour Doppler and cross sectional echocardiography in 87 patients (mean SD) age 57 (12) years) with hypertrophic cardiomyopathy, and 48 age matched controls (57 (8) years). Aortic regurgitant murmurs were recorded in only three of 87 patients and in none of the controls. Colour Doppler echocardiography showed an aortic regurgitant signal in 20 (23%) of the patients and three (6%) of the 48 controls. The colour Doppler signals typical of aortic regurgitation were limited to the left ventricular outflow tract. There were no significant differences between patients with hypertrophic cardiomyopathy with and without aortic regurgitation in terms of age (59 years v 56 years), blood pressure (140/84 mm Hg v 136/80 mm Hg), aortic diameter (34 mm v 33 mm), or frequency of calcification of the aortic valve (15% v 10%) and of systolic anterior motion of the mitral valve with mitral-septal contact (25% v 16%). On cross sectional echocardiograms, the degree of septal protrusion into the left ventricular outflow tract during systole was significantly more prominent (15 v 10 mm), and the portion of the basal septum that protruded most deeply into the left ventricular outflow tract was significantly closer to the aortic annulus in patients with aortic regurgitation than in those without it (11 v 14 mm). Mild aortic regurgitation was found in almost a quarter of patients with hypertrophic cardiomyopathy. The regurgitation was related to the morphological abnormality of the left ventricular outflow tract.