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Echocardiographic analysis of ventricular septal dynamics in hypertrophic cardiomyopathy and other diseases
Insights
The adynamic septum is not unique to hypertrophic cardiomyopathy (HC). Echocardiography shows similar septal thickening in HC and other cardiac conditions, especially when normalized for diastolic thickness.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- The adynamic or hypokinetic appearance of the ventricular septum is considered a unique echocardiographic feature of hypertrophic cardiomyopathy (HC).
- This characteristic has been used to differentiate HC from other cardiac conditions causing left ventricular (LV) hypertrophy and pressure overload.
Purpose of the Study:
- To determine how characteristic the adynamic septum is of hypertrophic cardiomyopathy (HC).
- To compare septal dynamics in patients with HC versus those with other cardiac diseases causing LV hypertrophy and pressure overload.
Main Methods:
- Echocardiography was performed on 70 patients with HC, 31 with other cardiac diseases (aortic valvular stenosis or systemic hypertension), and 25 healthy subjects.
- M-mode echocardiography was used to assess percent systolic thickening and excursion of the ventricular septum.
Main Results:
- 75% of HC patients showed reduced septal thickening or excursion, but 25% had normal septal dynamics.
- 36% of patients with other cardiac diseases had reduced systolic thickening, while 64% showed normal septal thickening and excursion.
- When normalized for diastolic septal thickness, differences in systolic septal thickening between HC and other cardiac diseases were not significant.
Conclusions:
- The adynamic septum is not a unique echocardiographic feature of hypertrophic cardiomyopathy (HC).
- Septal thickening, when adjusted for diastolic thickness, does not significantly differ between HC and other cardiac conditions causing pressure overload.
- Echocardiographic assessment of septal dynamics requires careful consideration of absolute septal thickness.
Abstract:
It has been suggested that the adynamic or hypokinetic appearance of the ventricular septum is a unique echocardiographic feature of hypertrophic cardiomyopathy (HC). To determine how characteristic of HC the adynamic septum is, 70 patients with this disease, and 31 with other cardiac diseases that produce left ventricular (LV) hypertrophy and pressure overload (aortic valvular stenosis or systemic hypertension), and 25 subjects with normal hearts were studied by echocardiography. On M-mode echocardiography, 53 of 70 patients (75%) with HC had an abnormally low value for percent systolic thickening of the septum associated with either reduced or normal septal excursion; however, 17 patients (25%) showed normal septal dynamics. Twenty of 31 patients (64%) with other cardiac diseases that produce pressure overload showed normal septal thickening and excursion, while 11 (36%) had reduced systolic thickening associated with either diminished or normal excursion. Greatly reduced values for percent systolic thickening of the septum were present both in patients with HC (13 +/- 1%) and in patients with other cardiac diseases (21 +/- 2%). However, differences in systolic septal thickening between the 2 groups were largely a manifestation of the greater absolute diastolic septal thickness in patients with HC. When values for percent systolic thickening were normalized for diastolic septal thickness, or when systolic thickening was compared in only patients with similar diastolic septal thicknesses, differences in septal thickening between patients with HC and those patients with other cardiac diseases were not significant.(ABSTRACT TRUNCATED AT 250 WORDS)