title: Tricuspid annular motion velocity as a differentiation index of hypertrophic cardiomyopathy from hypertensive heart disease.
abstract: BACKGROUND
  Hypertensive heart disease (HHD) and hypertrophic cardiomyopathy (HCM) are the most frequently encountered entities presenting left ventricular hypertrophy in routine echocardiographic examination, and their differentiation is sometimes difficult. Abnormalities in right ventricular (RV) myocardium have been reported frequently in patients with HCM more than in those with HHD. We therefore hypothesized that tricuspid annular motion (TAM) velocity determined by pulsed tissue Doppler echocardiography can be used to detect RV dysfunction in HCM and discriminate these etiologies.
  
  
  METHODS
  TAM velocities were compared among clinically stable patients with 60 HCM and 60 HHD patients as well as 60 age-matched healthy controls. Peak systolic, early diastolic (TAM-e'), and atrial systolic velocities were measured. RV myocardial performance index was measured by tissue Doppler method. To more accurately differentiate HCM from HHD, electrocardiographic findings and brain natriuretic peptide levels, which can both be examined simply and noninvasively, were investigated in addition to echocardiography.
  
  
  RESULTS
  RV wall thickness of the HCM group was greater than the HHD group (p=0.092), while there was no significant difference in RV myocardial performance index between the HCM and HHD groups (p=0.606). TAM-e' was significantly lower in the HCM group than in HHD and control groups (p=0.001). To differentiate HCM from HHD, TAM-e' was a powerful predictor as per multivariate logistic regression analysis (hazard ratio, 0.665; p<0.001) of parameters other than those of left ventricular parameters, and the area under the receiver operating characteristic curve (AUC) was 0.686 and the best cut-off value was ≤8.0cm/s (62% sensitivity, 65% specificity). Multivariate logistic analysis revealed that electrocardiographic ST-T changes were the next most effective marker for differentiating HCM after TAM-e'. When TAM-e' and ST-T changes were combined, the AUC increased to 0.748.
  
  
  CONCLUSIONS
  TAM-e' is a potentially useful index to differentiate HCM from HHD.
authors.affiliation: Ultrasound Examination Center, Tokushima University Hospital, Tokushima, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Hayashi
authors.affiliation: Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan. Electronic address: yamadah@tokushima-u.ac.jp.
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Yamada
authors.affiliation: Ultrasound Examination Center, Tokushima University Hospital, Tokushima, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Nishio
authors.affiliation: Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Hotchi
authors.affiliation: Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan.
authors.forename: Mika
authors.initials: M
authors.lastname: Bando
authors.affiliation: Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan.
authors.forename: Yuriko
authors.initials: Y
authors.lastname: Takagawa
authors.affiliation: Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan.
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Saijo
authors.affiliation: Ultrasound Examination Center, Tokushima University Hospital, Tokushima, Japan.
authors.forename: Yukina
authors.initials: Y
authors.lastname: Hirata
authors.affiliation: Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Sata
mesh_terms: D000368:Aged; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications / Q000503:physiopathology*; D016022:Case-Control Studies; D004452:Echocardiography; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D063177:Pulse Wave Analysis; D014261:Tricuspid Valve / Q000503:physiopathology*; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology
keywords: Hypertensive heart disease; Hypertrophic cardiomyopathy; Left ventricular hypertrophy; Tissue Doppler echocardiography; Tricuspid annular motion