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[Coronary circulation in asymmetrical hypertrophy of the interventricular septum. On a new pathogenic hypothesis]
Insights
Left ventricular hypertrophy patients were divided into concentric and asymmetric septal hypertrophy groups. Asymmetric septal hypertrophy showed distinct coronary artery branching patterns, impacting blood supply to the left ventricle.
Area of Science:
- Cardiology
- Cardiac Imaging
- Vascular Anatomy
Context:
- Left ventricular hypertrophy (LVH) is a significant cardiovascular condition.
- Understanding the subtypes of LVH, concentric hypertrophy (CH) and asymmetric septal hypertrophy (ASH), is crucial for diagnosis and management.
- Coronary artery anatomy may differ in patients with varying LVH patterns.
Purpose:
- To compare echocardiographic, electrocardiographic, and coronary angiographic findings in patients with concentric hypertrophy versus asymmetric septal hypertrophy.
- To investigate potential differences in coronary artery branching patterns between CH and ASH.
- To correlate cardiac structural changes with coronary vascularization in LVH.
Summary:
- Thirty-four patients with LVH were categorized into Group A (concentric hypertrophy, n=22) and Group B (asymmetric septal hypertrophy, n=12).
- Group B (ASH) exhibited greater R wave voltage in V2, interventricular thickness, and septal-to-posterior wall thickness ratio, with reduced septal movement and posterior wall thickness compared to Group A (CH).
- Distinct coronary artery patterns were observed: Group B showed significantly fewer first-order branches of the circumflex artery and a different distribution pattern of the anterior descending coronary artery, with the posterior descending artery dominating septal supply.
Impact:
- This study highlights significant differences in cardiac morphology and coronary artery anatomy between concentric and asymmetric septal hypertrophy.
- Findings suggest that asymmetric septal hypertrophy is associated with a less extensive coronary network supplying the left ventricle.
- These insights may inform risk stratification and therapeutic strategies for patients with different forms of left ventricular hypertrophy.
Abstract:
Thirty-four patients with left ventricular hypertrophy were studied. In all cases the following parameters were analyzed: 1) Echocardiography:left ventricular diastolic and systolic diameters, ejection fraction, thickness and movement of interventricular septum and posterior wall of the left ventricle (LV) 2) Electrocardiography: R wave voltaje in precordial leads V2, V3 and V5 and electrical axis in frontal plane 3) Catheterization: intracavitary pressures in LV and aortic pressures 4) Left ventriculography: areas of altered contractility 5) Coronariography: distribution pattern of coronary arteries and number of first order branches of circumflex (CA) and anterior descending coronary arteries (ADCA). The population was divided into 2 groups. Group A (GA) was made up of 22 patients with concentric hypertrophy (CH) of the LV (15 with systemic hypertensive heart disease, 6 with aortic valvular stenosis and 1 idiopathic). Echocardiographic findings included posterior wall thickness (PWT) or septal thickness of 1.1. cm or more and interventricular septum-posterior wall thickness ratio (S/PW) of less than 1.3. Group B (GB) included 12 patients with asymmetric septal hypertrophy (ASH), idiopathic in 5, systemic hypertensive heart disease in 4 and aortic valvular stenosis in 3. In these patients the S/PW thickness ratio was greater than 1.3 and the thickness of either wall greater than 1.1. cm. When the data of the two groups were compared there were significant differences in relation to the presence of septal hypertrophy. The R wave voltage in V2, interventricular thickness and S/PW were greater in GB. In addition, septal movement was less in GB than in Group A (0.47 +/- 0.26 cm vs. 0.74 +/- 0.37 cm; P less than 0.05). PWT was also less in Group B than in A (B: 1.01 +/- 0.1 cm, A: 1.2 +/- 0.2 cm; P less than 0.001). The CA in Group B divided into fewer than 4 first order branches to the upper two thirds of the posterior and lateral walls of the LV in 91.6%. This distribution of circumflex branches was found in 31.8% of the patients in Group A (P less than 0.05). In Group B, the ADCA divided into septal branches with no more than 2 diagonal branches. The posterior descending artery dominated septal distribution in 100% of these cases (GA: 31.8%; P less than 0.05). The sum of the first order branches of the CA and the ADCA was 5.6 +/- 0.9 in Group A and 2.7 +/- 0.9 branches in Group B (P less than 0.01).(ABSTRACT TRUNCATED AT 400 WORDS)