Isolated hypertrophy of the basal ventricular septum: characteristics of patients with and without outflow tract obstruction.
BACKGROUND
Isolated basal septal hypertrophy (IBSH) of the left ventricle (LV) is not a well understood phenomenon, particularly in the presence of concomitant left ventricular outflow tract obstruction (LVOTO). We evaluated the prevalence of IBSH and compared those with and without LVOTO.


METHODS
Retrospective observational study of 4104 consecutive patients undergoing echocardiography at a community cardiology practice and a hospital without specialized Hypertrophic Cardiomyopathy (HCM) service to determine prevalence of IBSH, defined as isolated hypertrophy (>15 mm) of the basal LV septum (BS) without hypertrophy elsewhere. Clinical, ECG and echocardiographic characteristics were compared in IBSH with and without LVOTO.


RESULTS
Prevalence of IBSH was 5.8% (240/4104): mean (SD) age was 76.0y (10.4) with equal gender distribution. Prevalence increased with age (p<0.001 for trend), reaching 7.8% over 70y. None had a family history of HCM, and HCM-associated ECG changes were uncommon. Mean BS thickness (SD) was 17.8mm (0.24) with a BS/posterior wall ratio (SD) of 1.76 (0.31). Resting peak LVOT gradient (>20mmHg) was present in 8/240 (3.3%), mean (SD) 69.6mmHg (59.3). Patients with LVOTO had hypercontractile LV function (fractional shortening [SD] 51.8% [9.5] vs. 40.5% [10.9], p=0.012) compared to those without LVOTO, but had similar BS thickness [SD] (17.8mm [3.0] vs. 17.8mm [2.8], p=0.996) and ECG characteristics. Greater apical and septal displacements of the mitral valve co-aptation point characterized those with IBSH and LVOTO.


CONCLUSIONS
IBSH is common in elderly patients referred for echocardiography. LVOTO occurs only when concomitant mitral valve co-aptation and LV hypercontractility facilitate development of a gradient, rather than through differences in the degree of BS myocardial hypertrophy.
Department of Cardiology & The University of Sydney, Sydney Medical School, Level 3 West, Concord Repatriation General Hospital, Hospital Road, Concord, Sydney, NSW 2139, Australia.
Isuru
I
Ranasinghe
Department of Cardiology & The University of Sydney, Sydney Medical School, Level 3 West, Concord Repatriation General Hospital, Hospital Road, Concord, Sydney, NSW 2139, Australia.
Chadi
C
Ayoub
Department of Cardiology & The University of Sydney, Sydney Medical School, Level 3 West, Concord Repatriation General Hospital, Hospital Road, Concord, Sydney, NSW 2139, Australia.
Chaitu
C
Cheruvu
Department of Cardiology & The University of Sydney, Sydney Medical School, Level 3 West, Concord Repatriation General Hospital, Hospital Road, Concord, Sydney, NSW 2139, Australia.
Saul B
SB
Freedman
Department of Cardiology & The University of Sydney, Sydney Medical School, Level 3 West, Concord Repatriation General Hospital, Hospital Road, Concord, Sydney, NSW 2139, Australia. Electronic address: john.yiannikas@yahoo.com.au.
John
J
Yiannikas
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014463:Ultrasonography; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D054088:Ventricular Septum / Q000000981:diagnostic imaging*
Cardiac hypertrophy; Epidemiology; Outflow tract obstruction; Sigmoid septum