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Use of pulsed Doppler tissue imaging to assess regional left ventricular diastolic dysfunction in hypertrophic
S Severino1, P Caso, M Galderisi
1Divisione di Cardiologia, Azienda Ospedaliera Monaldi, Italy.
Insights
Doppler tissue imaging (DTI) reveals impaired relaxation in hypertrophic cardiomyopathy (HC) diastolic dysfunction, particularly in the septum. This advanced imaging technique complements standard Doppler to assess regional diastolic properties and asynchrony in HC patients.
Area of Science:
- Cardiology
- Medical Imaging
- Physiology
Background:
- Hypertrophic cardiomyopathy (HC) is characterized by impaired diastolic function.
- Standard Doppler echocardiography provides insights into transmitral inflow patterns.
- Regional diastolic differences in HC require further investigation.
Purpose of the Study:
- To investigate regional diastolic patterns in hypertrophic cardiomyopathy (HC) using Doppler tissue imaging (DTI).
- To assess the relationship between DTI-derived parameters and transmitral Doppler inflow in HC.
- To characterize regional diastolic impairment and asynchrony in HC.
Main Methods:
- 20 HC patients and 10 healthy controls underwent Doppler echocardiography and DTI of the basal septum and lateral wall.
- Exclusion criteria included diabetes, hypertension, coronary/valvular disease, mitral regurgitation, advanced NYHA classes, and arrhythmias.
- Parameters analyzed included peak velocity, time-velocity integral of early (E) and late (A) waves, E/A ratios, deceleration time, and isovolumic relaxation time.
Main Results:
- HC patients showed reduced transmitral E/A ratios and prolonged deceleration and isovolumic relaxation times compared to controls.
- Septal DTI in HC revealed lower e/a ratios and prolonged regional deceleration and isovolumic relaxation times.
- Lateral wall DTI in HC showed prolonged deceleration and isovolumic relaxation times, indicating regional differences and diastolic asynchrony.
Conclusions:
- DTI is a valuable tool, complementary to standard Doppler, for assessing diastolic properties in HC.
- DTI demonstrates impaired intramyocardial relaxation, especially in the hypertrophied septum of HC patients.
- Diastolic asynchrony in HC is not limited to the hypertrophied segment, as evidenced by lateral wall involvement.
Abstract:
In this study, regional diastolic patterns and their relations with transmitral Doppler inflow were investigated in hypertrophic cardiomyopathy (HC) by pulsed Doppler tissue imaging (DTI). Doppler echocardiography and DTI of basal septum and lateral wall (apical 4-chamber view) were performed in 20 patients (15 men and 5 women) with HC and in 10 healthy subjects (7 men and 3 women). Diabetes, hypertension, coronary artery and valvular disease, mitral regurgitation, New York Heart Association functional classes III to IV, sinus tachycardia, atrial fibrillation, and inadequate echocardiograms were exclusion criteria. Peak velocity and time-velocity integral of early and late waves and their ratios, and deceleration and isovolumic relaxation times were determined by standard Doppler and by DTI at the septal and lateral wall levels. The 2 groups were comparable for age, heart rate, blood pressure, and ejection fraction. Transmitral peak velocity and time-velocity integral E/A ratios were reduced (both p <0.05) and deceleration and isovolumic relaxation times prolonged (both p <0.00001) in HC. Septal DTI showed lower peak velocity and time-velocity integral e/a ratios (p <0.00001 and p <0.001, respectively) and lengthened regional deceleration (p <0.01) and isovolumic (p <0.001) relaxation times. DTI of the lateral wall showed a prolongation of deceleration and isovolumic relaxation times (both p <0.01). By dividing HC according to transmitral E/A, 8 patients with E/A <1 had lower DTI septal e/a ratio (p <0.01) and prolonged septal deceleration and isovolumic relaxation times (both p <0.01) but no changes in DTI pattern of lateral wall than 12 patients with E/A > 1. In conclusion, DTI is useful and complementary to standard Doppler imaging to characterize diastolic properties in HC, reflecting a typical pattern of intramyocardial impaired relaxation at the level of hypertrophied septum and also providing information about the degree of this regional impairment. The lateral wall presents minor changes in diastolic times, which indicate how diastolic asynchrony is not confined to the hypertrophied segment in HC.
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