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Left ventricular long-axis function in hypertrophic cardiomyopathy - Relationships between e`, early diastolic
Roger E Peverill1, Bon Chou1, Lesley Donelan1
1Monash Cardiovascular Research Centre, MonashHeart and Department of Medicine, School of Clinical Sciences at Monash Health, Monash University and Monash Health, Clayton, Victoria, Australia.
Insights
In hypertrophic cardiomyopathy (HCM), reduced left ventricular (LV) longitudinal contraction limits early diastolic motion. This, along with prolonged early diastolic motion, lowers early diastolic mitral annular velocity (e`).
Area of Science:
- Cardiology
- Cardiovascular Physiology
- Echocardiography
Background:
- Early diastolic mitral annular velocity (e`) is a key indicator of left ventricular (LV) diastolic dysfunction in hypertrophic cardiomyopathy (HCM).
- Other aspects of LV long-axis function in HCM, including systolic excursion (SExc) and early diastolic excursion (EDExc), are less understood.
- The impact of HCM on atrial contraction excursion (AExc) and early diastolic motion duration (EDDur) remains unclear.
Purpose of the Study:
- To investigate the effects of HCM on various parameters of LV long-axis function during diastole.
- To explore the relationships between systolic and diastolic mitral annular excursion and early diastolic velocity.
- To identify independent predictors of early diastolic mitral annular excursion and velocity in HCM.
Main Methods:
- Compared 22 subjects with HCM to 22 age- and sex-matched controls.
- Measured SExc, EDExc, e`, AExc, and EDDur using pulsed wave tissue Doppler imaging of septal and lateral walls.
- Utilized multivariate regression analyses to identify predictors of EDExc and e`.
Main Results:
- HCM group showed lower SExc, EDExc, and e`, and longer EDDur compared to controls (p<0.05).
- Septal AExc was lower in HCM, but lateral AExc was not significantly different.
- SExc strongly predicted EDExc (57-86% variance), and EDExc (with EDDur) strongly predicted e` (58-92% variance).
Conclusions:
- Reduced LV longitudinal contraction is the primary cause of decreased EDExc in HCM.
- Lower e` in HCM results from reduced EDExc and prolonged early diastolic motion.
- Atrial contraction does not compensate for the impaired longitudinal function in HCM.
Background:
The peak velocity of early diastolic mitral annular motion (e`) is believed to provide sensitive detection of left ventricular (LV) diastolic dysfunction in hypertrophic cardiomyopathy (HCM), but other aspects of LV long-axis function in HCM have received less attention. Systolic mitral annular excursion (SExc) is also reduced in HCM and must be an intrinsic limitation to the extent of the subsequent motion during diastole. However, the effects of HCM on excursion during early diastole (EDExc) and atrial contraction (AExc), the duration of early diastolic motion (EDDur), and the relationships of EDExc with SExc, and of e`with EDExc and EDDur, are all unknown.
Methods:
The study group was 22 subjects with HCM and there were 22 age and sex matched control subjects. SExc, EDExc, e`, AExc and EDDur were measured from pulsed wave tissue Doppler signals acquired from the septal and lateral walls. In the combined group of HCM and control subjects, multivariate analyses were performed to identify independent predictors of EDExc and e`for both LV walls.
Results:
SExc, EDExc and e`were all lower, and EDDur was longer in the HCM group compared to the control group for both LV walls (p<0.05 for all). In contrast, AExc was lower for the septal wall in the HCM group (p<0.05), but not different between the groups for the lateral wall. In regression analyses of the combined group, EDExc was positively correlated with SExc, and SExc explained 57-86% of the variances in septal and lateral EDExc, e`was positively correlated with EDExc, and EDExc explained 58-68% of the variances of e`, whereas the combination of EDExc with EDDur explained 87-92% of the variances in e`. A diagnosis of HCM was not an independent predictor of EDExc when in combination with SExc, but was a minor contributor to the prediction of e`in combination with EDExc and EDDur.
Conclusion:
In HCM, the decrease in LV longitudinal contraction is the major mechanism accounting for a lower EDExc, the lower e`is accounted for by contributions from the lower EDExc and prolongation of early diastolic motion, and there is no atrial compensation for the reduction of long-axis contraction.
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