title: Discrimination of nonobstructive hypertrophic cardiomyopathy from hypertensive left ventricular hypertrophy on the basis of strain rate imaging by tissue Doppler ultrasonography.
abstract: BACKGROUND
  The differentiation of hypertrophic cardiomyopathy (HCM) from hypertensive left ventricular hypertrophy (H-LVH) on the basis of morphological information obtained by conventional echocardiography is occasionally problematic. We investigated whether strain rate (SR) imaging derived from tissue Doppler imaging (TDI) is able to discriminate HCM from H-LVH.
  
  
  RESULTS
  Conventional echocardiography and TDI were performed with 34 patients with LVH and 16 reference subjects. Mean values of systolic strain (epsilon(sys)), peak systolic SR, and early diastolic SR obtained from 8 left ventricular (LV) segments were calculated. LV pressures were recorded simultaneously in the patients. Patients were diagnosed with HCM (n=20) or H-LVH (n=14) on the basis of conventional echocardiography and endomyocardial biopsy findings. Multivariate analysis revealed that septum/posterior wall thickness ratio (P=0.00013) and epsilon(sys) (P<0.0001) were each able to discriminate HCM from H-LVH. A epsilon(sys) cutoff value of -10.6% discriminated between HCM and H-LVH with a sensitivity of 85.0%, specificity of 100.0%, and predictive accuracy of 91.2%. The combination of the septum/posterior wall thickness ratio and epsilon(sys) discriminated HCM from H-LVH with a predictive accuracy of 96.1%. The epsilon(sys) parameter was significantly correlated with pulmonary arterial wedge pressure, LV end-diastolic pressure, the peak positive first derivative of LV pressure, and the time constant of LV pressure decay.
  
  
  CONCLUSIONS
  SR imaging is able to discriminate HCM from H-LVH, with epsilon(sys) reflecting myocardial contractile and lusitropic properties.
authors.affiliation: Department of Clinical Pathophysiology, Nagoya University, Graduate School of Medicine, Nagoya, Japan.
authors.forename: Tomoko S
authors.initials: TS
authors.lastname: Kato
authors.forename: Akiko
authors.initials: A
authors.lastname: Noda
authors.forename: Hideo
authors.initials: H
authors.lastname: Izawa
authors.forename: Akira
authors.initials: A
authors.lastname: Yamada
authors.forename: Koji
authors.initials: K
authors.lastname: Obata
authors.forename: Kohzo
authors.initials: K
authors.lastname: Nagata
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Iwase
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Yokota
mesh_terms: D000368:Aged; D001706:Biopsy; D006328:Cardiac Catheterization; D002302:Cardiac Output; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging* / Q000473:pathology; D015150:Echocardiography, Doppler / Q000379:methods*; D018618:Echocardiography, Doppler, Color; D004699:Endocardium / Q000473:pathology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D032383:Myocytes, Cardiac / Q000473:pathology; D011669:Pulmonary Wedge Pressure; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013314:Stress, Mechanical