Tissue Doppler imaging assessment of long axis left ventricular function in hypertensive patients with concentric left ventricular hypertrophy: differential diagnosis with hypertrophic cardiomyopathy.
BACKGROUND
The differential diagnosis between hypertrophic cardiomyopathy and hypertensive heart disease has clinical, therapeutic and prognostic implications, but is not always easy with conventional echocardiography. Tissue Doppler imaging of the mitral annulus allows the detailed study of long axis left ventricular function in hypertrophic cardiomyopathy and may be useful in the differential diagnosis.


METHODS
23 patients with non-obstructive hypertrophic cardiomyopathy and 25 hypertensive patients with concentric left ventricular hypertrophy with similar age, body surface and heart rate were studied with pulsed tissue Doppler imaging of the 4 sides of the mitral annulus (septal, lateral, inferior, anterior) in 4 and 2 chamber views. In each wave (systolic-s, rapid filling-e, atrial contraction-a) we analyzed velocities, time intervals and velocity-time integrals, as well as heterogeneity and asynchrony. Data were compared among the different sides in each group, between groups and with conventional Doppler data.


RESULTS
In contrast to hypertensive patients, hypertrophic cardiomyopathy patients showed: 1--Systolic function: lower "s" wave velocities and integrals, higher systolic heterogeneity, longer isovolumic relaxation time and higher PEP/LVET (pre ejection period/left ventricular ejection time). 2--Diastolic function: lower "e" and "a" wave, higher "a" and "e/a" heterogeneity index, higher percentage of annular sides with e/a > or = l, longer isovolumic relaxation time and time to peak e, and higher diastolic asynchrony. Some of these abnormalities occurred in annular sides adjacent to non-hypertrophied walls.


CONCLUSIONS
This study shows that: 1--Long axis systolic and diastolic left ventricular function are significantly different between hypertrophic cardiomyopathy patients and hypertensive patients with concentric left ventricular hypertrophy. 2--These functional differences occur in the velocity domain (with heterogeneity), in the time domain (with asynchrony) and also in velocity time integrals. 3--Long axis systolic and diastolic dysfunction occur in annular sides contiguous to hypertrophied and non-hypertrophied walls, enhancing the role of tissue Doppler imaging in the differential diagnosis between these diseases.
Serviço de Cardiologia, Hospital Pulido de Valente, Lisboa. Corclinica@clix.pt
Nuno
N
Cardim
Susana
S
Longo
Teresa
T
Ferreira
Amadeu
A
Pereira
António
A
Gouveia
Roberto Palma
RP
Reis
João Martins
JM
Correia
D000368:Aged; D000369:Aged, 80 and over; D006332:Cardiomegaly / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003937:Diagnosis, Differential; D003971:Diastole; D018619:Echocardiography, Doppler, Pulsed / Q000379:methods*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000000981:diagnostic imaging*; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D011446:Prospective Studies; D013599:Systole; D013997:Time Factors