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Systolic and diastolic flow abnormalities in elderly patients with hypertensive hypertrophic cardiomyopathy
A C Pearson1, C V Gudipati, A J Labovitz
1Department of Internal Medicine, St. Louis University Medical Center, Missouri.
Insights
Elderly patients with hypertensive hypertrophic cardiomyopathy exhibit thickened left ventricles and impaired filling. Many also show outflow tract obstruction, similar to hypertrophic obstructive cardiomyopathy.
Area of Science:
- Cardiology
- Geriatric Medicine
- Cardiovascular Physiology
Background:
- Hypertensive hypertrophic cardiomyopathy is a common condition in the elderly.
- Left ventricular structure and function in this specific patient group require further characterization.
Purpose of the Study:
- To comprehensively assess left ventricular systolic and diastolic function in elderly patients with hypertensive hypertrophic cardiomyopathy.
- To compare cardiac structure and function against age-matched healthy controls.
Main Methods:
- Echocardiographic measurements of left ventricular structure (mass, wall thickness, dimensions).
- Assessment of left ventricular systolic function (shortening fraction).
- Evaluation of left ventricular diastolic function (filling patterns, velocities) and outflow tract velocities.
Main Results:
- Study patients showed significantly increased left ventricular mass, wall thickness, and relative wall thickness compared to controls.
- Impaired left ventricular filling characterized by altered peak atrial and early filling velocities was observed.
- Elevated left ventricular outflow tract velocities and intraventricular gradients, resembling hypertrophic obstructive cardiomyopathy, were present in most patients.
Conclusions:
- Elderly patients with hypertensive hypertrophic cardiomyopathy present a pathophysiologic state closely mimicking hypertrophic obstructive cardiomyopathy.
- Findings support considering pharmacologic agents with negative inotropic or positive lusitropic properties for managing these patients.
Abstract:
Seventeen patients with clinical and echocardiographic features of hypertensive hypertrophic cardiomyopathy of the elderly were studied to more completely characterize left ventricular systolic and diastolic function in this group. Measurements of left ventricular structure and systolic and diastolic function were made in the study patients and compared with those of age-matched control subjects. The study group had significantly greater left ventricular mass, wall thickness, shortening fraction and relative wall thickness than did the control subjects. Left ventricular end-diastolic dimension was smaller and left atrial size was not different in study patients compared with control subjects. Left ventricular filling was characterized by an increased peak atrial velocity and reduced ratio of peak early to peak atrial velocity in the study group. Left ventricular outflow velocities were elevated in 14 of the 17 study patients with peak velocities ranging from 1.2 to 5.0 m/s corresponding to a peak intraventricular gradient of 16 to 100 mm Hg. The velocity waveforms in these patients were late-peaking, similar to those described in hypertrophic obstructive cardiomyopathy. The elevated velocities were localized to the left ventricular outflow tract. These findings imply a pathophysiologic state in these elderly patients with long-standing hypertension, very similar to that in hypertrophic obstructive cardiomyopathy, and provide further support for the use of pharmacologic agents with negative inotropic properties or positive lusitropic properties in this group.