title: Three-layer ultrasonic tissue characterization of the ventricular septum is predictive of prognosis in patients with non-obstructive hypertrophic cardiomyopathy.
abstract: OBJECTIVE
  A necropsy study of patients with hypertrophic cardiomyopathy (HCM) who died at a young age exhibited marked disarray and fibrosis in the mid-wall layer of the left ventricular (LV) myocardium. We assessed ultrasonic tissue characteristics in the three layers of the ventricular septum (VS), and correlated the result with long-term prognosis in HCM.
  
  
  RESULTS
  The magnitude of cyclic variation of integrated backscatter (CV-IB) was calculated in the three layers of the VS and the whole aspect of the LV posterior wall in 58 non-obstructive HCM patients and 20 healthy controls. All HCM patients were prospectively followed for an average period of 7.1 years for the occurrence of cardiac death or hospitalization due to heart failure. Each CV-IB of four regions was lower in HCM patients than in controls (all P < 0.01). CV-IB of the VS mid-wall layer was lower in 14 HCM patients with cardiac events than in patients without (5.4 ± 0.6 vs. 7.4 ± 0.5 dB, P = 0.033) although CV-IB of three other regions did not differ between the two groups. The optical cut-off point of %CV-IB <90%, i.e. the ratio of CV-IB in the VS mid-wall layer to the mean value in the layers on both sides, was an independent predictor of cardiac events (hazard ratio, 6.12; 95% confidence interval, 1.62-66.6; P = 0.013), with a positive predictive value of 44% and particularly with a high negative predictive value of 91%.
  
  
  CONCLUSIONS
  Patients with non-obstructive HCM are not likely to undergo cardiac events in the near future, when the CV-IB value is not significantly lower in the VS mid-wall layer than in the layers on both sides.
authors.affiliation: Department of Cardiology, Matsushita Memorial Hospital, Sotojima 5-55, Moriguchi, Osaka 570-8540, Japan. js-k@wf6.so-net.ne.jp
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Kawasaki
authors.forename: Michiyo
authors.initials: M
authors.lastname: Yamano
authors.forename: Toshiro
authors.initials: T
authors.lastname: Kuribayashi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kaimoto
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Miki
authors.forename: Tadaaki
authors.initials: T
authors.lastname: Kamitani
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Matsubara
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sugihara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging* / Q000473:pathology; D016022:Case-Control Studies; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D013223:Statistics as Topic; D018608:Ultrasonography, Doppler; D054088:Ventricular Septum / Q000000981:diagnostic imaging* / Q000473:pathology