'Pseudo' systolic anterior motion in patients with hypertensive heart disease

The systolic motion of the mitral apparatus in patients with hypertensive heart disease and hypertrophic cardiomyopathy was studied in order to quantify the difference. Twelve out of 37 patients with severe systemic hypertension were found to have abnormal systolic anterior motion and had significantly small left ventricular end-systolic dimension (P less than 0.05) and greater ejection fraction and mean velocity of circumferential fibre shortening (P less than 0.01 for each) than the other hypertensive patients without abnormal systolic anterior motion. A comparison between systolic anterior motion in 12 hypertensive patients and mild or moderate systolic anterior motion in 28 patients with hypertrophic cardiomyopathy showed a clear cut difference. 'Pseudo' systole anterior motion reached its peak at end-systole when the posterior wall had contracted fully. 'True' systolic anterior motion, however, reached its peak much earlier than maximum movement of the posterior wall--approximately after two-thirds of systole had been completed. At the time of mitral valve opening, 'pseudo' systolic anterior motion had not yet returned to this initial level, whereas 'true' systolic anterior motion returned prior to the opening of the mitral valve. Anterior chordal motion in hyperdynamic ventricle appears to play a role in the production of 'pseudo' systolic anterior motion.