Tissue Doppler imaging and long axis left ventricular function: hypertrophic cardiomyopathy versus athlete's heart.
BACKGROUND
The different diagnosis between hypertrophic cardiomyopathy and athlete's heart has important clinical implications. The assessment of long axis left ventricular function with tissue Doppler imaging in hypertrophic cardiomyopathy (showing systolic and diastolic dysfunction with heterogeneity and asynchrony), may be useful in the differentiation of these situations.


OBJECTIVE
To study, with tissue Doppler imaging, long axis left ventricular function in a population of athletes (rowers) and to compare it with a population of non-obstructive hypertrophic cardiomyopathy patients.


METHODS
In 24 patients with non-obstructive hypertrophic cardiomyopathy and in 20 competitive rowers with similar age, blood pressure and heart rate, we analyzed mitral annulus motion with pulsed tissue Doppler imaging in the 4 sides of the annulus (septal, lateral, inferior, anterior), in apical views. In each wave (systolic, rapid filling and atrial contraction) we measured velocities, time intervals and velocity-time integrals, and calculated heterogeneity and asynchrony indices. Data were compared between the groups, between the different sides in each group ("parallel analysis") and with conventional indices of global function.


RESULTS
Hypertrophic cardiomyopathy patients showed: systolic function: lower velocities and integrals, shorter ejection time and shorter systolic time. These abnormalities occurred even in annular sites contiguous to walls without hypertrophy. DIASTOLIC FUNCTION: Much lower rapid filling velocities and integrals, lower atrial contraction velocities and integrals, lower e/a, longer isovolumic relaxation time and time to peak rapid filling wave. These abnormalities occurred even in annular sites adjacent to walls without hypertrophy. In the athletes group, the e/a ratio was never < 1, in any annular site. In hypertrophic cardiomyopathy patients this ratio was < 1 in 27% of the sites.


CONCLUSIONS
1--Systolic and diastolic long axis left ventricular function is different in hypertrophic cardiomyopathy and in athletes, in all mitral annulus sides. 2--The presence of these abnormalities in annular sites contiguous to walls without hypertrophy suggests that this technique may be useful in the differential diagnosis between these groups, particularly in the "gray zone" of Maron.
Serviço de Cardiologia, Hospital Pulido Valente, Lisboa. corclinica@clix.pt
Nuno
N
Cardim
Rui
R
Cordeiro
Maria João
MJ
Correia
Eustáquio
E
Gomes
Susana
S
Longo
Teresa
T
Ferreira
Amadeu
A
Pereira
António
A
Gouveia
Roberto Palma
RP
Reis
João Martins
JM
Correia
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D006332:Cardiomegaly / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003937:Diagnosis, Differential; D018619:Echocardiography, Doppler, Pulsed / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D011446:Prospective Studies; D015203:Reproducibility of Results; D013177:Sports / Q000502:physiology*; D013997:Time Factors; D016277:Ventricular Function, Left