title: Peripheral microvascular function is altered in young individuals at risk for hypertrophic cardiomyopathy and correlates with myocardial diastolic function.
abstract: Hypertrophic cardiomyopathy (HCM) is a major cause of sudden cardiac death in the young. Based on previous reports of functional abnormalities in not only coronary but also peripheral vessels in adults with HCM, we aimed to assess both peripheral vascular and myocardial diastolic function in young individuals with an early stage of HCM and in individuals at risk for HCM. Children, adolescents, and young adults (mean age: 12 yr) with a family history of HCM who either had (HCM group; n = 36) or did not have (HCM-risk group; n = 30) echocardiography-documented left ventricular (LV) hypertrophy as well as healthy matched controls (n = 85) and healthy young athletes (n = 12) were included in the study. All underwent assessment with 12-lead electrocardiography, two-dimensional echocardiography, tissue Doppler imaging and laser Doppler with transdermal iontophoresis of ACh and sodium nitroprusside. LV thickness and mass were increased in HCM and athlete groups compared with control and HCM-risk groups. The mitral E-to-e' ratio, measured via tissue Doppler, was increased in HCM (P < 0.0001) and HCM-risk (P < 0.01) groups compared with control and athlete groups, as were microvascular responses to ACh (HCM group: P = 0.045 and HCM-risk group: P = 0.02). Responses to ACh correlated with the E-to-e' ratio (r = 0.5, P = 0.001). Microvascular responses to sodium nitroprusside were similar in all groups (P > 0.2). HCM-causing mutations or its familial history are associated with changes in cardiac diastolic function and peripheral microvascular function even before the onset of myocardial hypertrophy. Tissue Doppler can be used to differentiate HCM from physiological LV hypertrophy in young athletes.
authors: Department of Pediatric Cardiology, Pediatric Heart Center, Skane University Hospital and Clinical Sciences, Lund University, Lund, Sweden; Department of Pediatrics, Linkoping University Hospital, Linkoping, Sweden; and eva.fernlund@med.lu.se.
authors: Eva
authors: E
authors: Fernlund
authors: Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
authors: Todd T
authors: TT
authors: Schlegel
authors: Department of Cardiology, Skane University Hospital and Clinical Sciences, Lund University, Lund, Sweden;
authors: Pyotr G
authors: PG
authors: Platonov
authors: Department of Cardiology, Skane University Hospital and Clinical Sciences, Lund University, Lund, Sweden;
authors: Jonas
authors: J
authors: Carlson
authors: Department of Clinical Physiology and Nuclear Medicine, Skane University Hospital and Clinical Sciences, Lund University, Lund, Sweden;
authors: Marcus
authors: M
authors: Carlsson
authors: Department of Pediatric Cardiology, Pediatric Heart Center, Skane University Hospital and Clinical Sciences, Lund University, Lund, Sweden;
authors: Petru
authors: P
authors: Liuba
mesh_terms: D000293:Adolescent; D056352:Athletes; D016022:Case-Control Studies; D002648:Child; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D020022:Genetic Predisposition to Disease; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000235:genetics / Q000503:physiopathology*; D008297:Male; D055806:Microvessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D016276:Ventricular Function; D055815:Young Adult
keywords: athletes' heart; diastology; early diagnosis; endothelium; myocardial hypertrophy