The left ventricular regional systolic functions in patients with hypertrophic cardiomyopathy (HCM) were assessed by using quantitative tissue velocity imaging (QTVI). Left ventricular (LV) regional myocardial velocity along long- and short-axis in 31 HCM patients and 20 healthy subjects were analyzed by QTVI, and the regional myocardial systolic peak velocities (MVS) were measured. Mean MVS at each level including mitral annular, basal, middle and apical segments were calculated. The ratio of MVS along long-axis to that along short-axis (Ri) at basal and middle segments of the LV posterior wall and ventricular septum were calculated. The results showed that mean MVS was slower at each level including mitral annular, basal, middle and apical segments in the HCM patients than that in the healthy subjects (P < 0.01). There were no significant differences in mean MVS between obstructive and non-obstructive groups in HCM patients. MVS of all regional myocardial segments along long-axis in the HCM patients were significantly slower than that in the healthy subjects (P < 0.05), but there was no significant difference in MVS of all regional myocardial segments along long-axis between hypertrophied and non-hypertrophied group in the HCM patients. Ri was significantly lower in the HCM patients than that in the healthy subjects. The LV regional myocardial contractility along long-axis was impaired not only in the hypertrophied wall but also in the non-hypertrophied one in patients with HCM, suggesting that QTVI can assess accurately LV regional systolic function in patient with HCM and provides a novel means for an early diagnosis before and independent of hypertrophy.
Cardiomyopathy, Hypertrophic/*physiopathology ; Cardiomyopathy, Hypertrophic/ultrasonography ; *Echocardiography, Doppler/methods ; Ventricular Function, Left/*physiology

The case is a 54-year-old man with hypertrophic cardiomyopathy, mid-ventricular obstruction, apical aneurysm, and recurrence sustained monomorphic ventricular tachycardia (VT). A coronary angiogram revealed myocardial bridging located in the middle of the left anterior descending coronary artery (LAD), and the left ventriculogram showed an hour-glass appearance of the left ventricular cavity. There was a significant pressure gradient of 60 mmHg across the mid-ventricular obliteration at rest. A successful myectomy of the inappropriate hypertrophy myocardium and excision of the apical aneurysm were performed. Pathologic analysis demonstrated fibrosis in the apical aneurysm and thickened and narrowed vessels in the adjacent area. During the follow-up of eighteen months, the patient remained clinically stable and free from arrhythmic recurrence.
Cardiomyopathy, Hypertrophic ; diagnosis ; physiopathology ; Female ; Heart Aneurysm ; physiopathology ; Humans ; Male ; Middle Aged ; Tachycardia, Ventricular ; physiopathology

To assess the left ventricular regional relaxation abnormalities in patients with hypertrophic cardiomyopathy (HCM) by quantitative tissue velocity imaging (QTVI), Doppler echocardiography and QTVI were performed in HCM (n=10) and healthy subjects (n=11) at apical long-axis, two-chamber and four-chamber views. Regional early diastolic velocity (rVe) and regional atrial contraction (rVa) were measured at each segment of ventricular middle, basal and annular levels. Mean rVe and mean rVa at three levels as well as mean rVe/rVa ratio were calculated. Our results showed that transmitral inflow peak velocities during early diastole (E) and atrial contraction (A) were also measured and E/A ratio was calculated. The rVe of all left ventricular segments in HCM were lower than those in healthy subjects (P<0.05), but compared with healthy subjects majority of rVa in HCM were not different except inferior wall and anterior wall. E between HCM and healthy subjects was different (P=0.036), while mean rVe between them was significantly different (P<0.0001). Mean rVa and mean rVe/rVa of three levels were lower in HCM than in healthy subjects (P<0.05), but there were no differences in A and E/A between them (P=0.22, P=0.101). Left ventricular regional myocardial relaxation is reduced in HCM. Transmitral inflow E and A are influenced by preload, relaxation of myocardium and atrial contraction, etc., while rVe and rVa reflect myocardial relaxation function independently. QTVI is more sensitive and more accurate than conventional Doppler imaging for characterizingregional diastolic properties in HCM.
Cardiomyopathy, Hypertrophic/*physiopathology ; Cardiomyopathy, Hypertrophic/*ultrasonography ; Diastole ; Echocardiography, Doppler, Color/methods ; Hypertrophy, Left Ventricular/*physiopathology ; Hypertrophy, Left Ventricular/ultrasonography ; Ventricular Function, Left

Animals ; Cardiomyopathy, Hypertrophic ; drug therapy ; physiopathology ; Disease Models, Animal ; Enalapril ; pharmacology ; therapeutic use ; Rabbits ; Ventricular Remodeling

Cardiomyopathy, Hypertrophic ; etiology ; pathology ; physiopathology ; Coronary Angiography ; Coronary Disease ; complications ; physiopathology ; Coronary Vessel Anomalies ; etiology ; pathology ; physiopathology ; Humans ; Myocardium ; pathology

OBJECTIVETo analyze the endocardial, myocardial, and epicardial longitudinal systolic strain (LSsys) in the left ventricle (LV) segments and walls in patients with cardiac involvement due to primary amyloidosis (AL-CA) and hypertrophic cardiomyopathy (HCM).

METHODSTwenty patients with biopsy-proven AL-CA, 20 with asymmetric HCM, and 20 age-matched healthy volunteers were analyzed for their clinical characteristics and underwent conventional echocardiography for evaluating LV wall thickness, left atrial and ventricle size, systolic and diastolic function and 2-dimensional velocity vector imaging for evaluating the endocardial, myocardial and epicardial LSsys of the LV segments and walls. AL-CA and HCM patients also underwent cardiac magnetic resonance to evaluate the late gadolinium enhancement (LGE) features.

RESULTSCompared with the control group, AL-CA and HCM groups, with similar clinical symptoms and physical signs, both showed increased LV wall thickness, left atrial diameter, E/A ratio, septal E/e' ratio and the prevalence of granular sparkling. LV segments and walls endocardial LSsys were significantly lower in AL-CA patients than in HCM patients and the control subjects. The endocardial-epicardial LSsys difference in all the left ventricle walls were significantly smaller in AL-CA group than in the control group, but this difference appeared variable in HCM group. The LGE also presented with different features in AL-CA and HCM: AL-CA group showed subendocardial LGE in almost all the LV walls, but HCM group showed patchy LGE with a regional, multifocal distribution.

CONCLUSIONAL-CA is characterized by a significantly reduced endocardial LSsys in the LV segments and an uniform decrease of the endocardial-epicardial LSsys difference in all the LV walls, but the changes in HCM appear variable, and 2-dimensional velocity vector imaging is therefore a useful modality to differentiate AL-CA from HCM.

Amyloidosis ; diagnosis ; Cardiomyopathy, Hypertrophic ; diagnosis ; Diagnosis, Differential ; Diastole ; Echocardiography ; Heart Ventricles ; physiopathology ; Humans ; Immunoglobulin Light-chain Amyloidosis ; Systole

OBJECTIVETo determine the clinical application of pulsed Doppler tissue imaging in assessing the left ventricular diastolic function and in discriminating between normal subjects and patients with hypertrophic cardiomyopathy with various stages of diastolic dysfunction.

METHODSWe measured the peak diastolic velocities of mitral annulus in 81 patients with hypertrophic cardiomyopathy with various stages of diastolic dysfunction and 50 normal volunteers by Doppler tissue imaging using the apical window at 2-chamber and long apical views, respectively. The myocardial velocities were determined with use of variance F statistical analysis.

RESULTSEarly diastolic myocardial velocities of mitral annulus were higher in normal subjects than in patients with hypertrophic cardiomyopathy with either delayed relaxation, pseudonormal filling, or restrictive filling. However, peak myocardial velocities of mitral annulus during atrial contraction were similar in normal subjects and patients with hypertrophic cardiomyopathy.

CONCLUSIONDoppler tissue imaging can directly reflect upon left diastolic ventricular function. Early phase of diastole was the best discriminator between control subjects and patients with hypertrophic cardiomyopathy.

Adult ; Cardiomyopathy, Hypertrophic ; diagnostic imaging ; physiopathology ; Diastole ; physiology ; Echocardiography, Doppler ; methods ; Humans ; Middle Aged ; Ventricular Function, Left

BACKGROUNDEffect of percutaneous transluminal septal ablation (PTSA) with ethanol injection on electromechanical remodeling of left ventricule still remains unknown. This study was conducted to assess the potential significance of cardiac electromechanical mapping (CEMM) in analyzing the left ventricular remodeling before and immediately after percutaneous transseptal myocardial ablation (PTSMA) in patients with hypertrophic obstructive cardiomyopathy (HOCM).

METHODSEight patients with drug-refractory HOCM and 6 patients with hypertrophic cardiopathy (HM) without increased left ventricular outtract gradien (LVOTG) were enrolled into the present study. CEMM was undergone in patients with HOCM before and immediately after PTSA procedure, and in patients with HM.

RESULTSPTSA was successful in all patients with HOCM, LVOTG significantly decreased from (62.87 +/- 21.16) mmHg to (12.73 +/- 3.05) mmHg immediately after ablation procedure. Value of UVP in septal-base segment in HM group was higher than that in HOCM group [(22.79 +/- 2.34) mV vs (18.54 +/- 1.76) mV]. In patients with HOCM, lateral-middle and -base segments had lowest value of UVP [(15.93 +/- 1.11) mV and (15.83 +/- 1.07) mV] before PTSA. Value of UVP at posterior-middle segment decreased from (23.58 +/- 2.21) mV pre-PTSA to (18.89 +/- 1.91) mV post-procedure, PTSA led to significant increase of UVP at lateral-middle segment. Septal region in patients with HM and septal-middle, septal-base, posterior-base segments in HOCM had lower value of local linear shortening (LLS) among all patients in both HOCM and HM groups. PTSA resulted in significant reduction of LLS in anterior region and at septal-apex segment. Anterior-base and septal-middle segments in patients with HM had lowest value of local active time (LAT), and significantly differentiated from that in patients with HOCM [(-8.57 +/- 0.68) ms vs (-18.61 +/- 1.02) ms, (-6.75 +/- 0.37)ms vs (-21.90 +/- 0.96) ms, respectively]. LAT at septal-middle and -base segments in patients with HOCM was decreased significantly [(-21.90 +/- 0.96) ms vs (-13.80 +/- 1.04) ms, P < 0.002; and (-15.20 +/- 1.06) ms vs (-6.33 +/- 0.52) ms, respectively] immediately after PTSA.

CONCLUSIONSPosterior-lateral and anterior region probably played important roles in electromechanical remodeling. Significant electromechanical remodeling disassociation (uncoupling) was detected in most left ventricular regions, which would be important in differentiating of HOCM from HM, and in predicting the prognosis in patients with HOCM after PTSA procedure.

Body Surface Potential Mapping ; Cardiomyopathy, Hypertrophic ; physiopathology ; therapy ; Ethanol ; therapeutic use ; Heart Septum ; drug effects ; Humans ; Ventricular Remodeling ; physiology

OBJECTIVETo evaluate the immediate and follow-up results of percutaneous transluminal septal myocardial ablation (PTSMA) in patients with hypertrophic obstructive cardiomyopathy (HOCM).

METHODSFifteen symptomatic, drug-refractory patients with HOCM underwent PTSMA procedures with application of a myocardial contrast echocardiography (MCE) intra-procedure. Before and after the procedure, clinical evaluations were obtained in all patients, who were followed up for a mean period of 8.6 +/- 3.8 (6-20) months.

RESULTSImmediate left ventricular outflow tract gradient (LVOTG) reduction was achieved (77.93 +/- 22 mm Hg vs 14.8 +/- 15 mm Hg, P < 0.0001) after the procedure with a mean decrease of 5.75 +/- 2.87 mm Hg of left ventricular end diastolic pressure (P < 0.001). Follow up results revealed that ventricular remodelling occurred mainly 1-3 months after the procedure, but without evidence of ventricular dilation and contract dysfunction. Heart function (NYHA) was greatly improved (3.4 +/- 0.5 vs 1.1 +/- 0.4, P < 0.001) and exercise endurance increased. A renewed increase of LVOTG was found in 2 patients during follow-up.

CONCLUSIONSLVOTG was greatly decreased in HOCM patients undergoing a PTSMA procedure, and their symptoms were greatly improved without cardiac complications during follow-up. Sub-selection and reopening of target vessels were the causes of renewed increase of LVOTG, and this can be avoided with the accumulation of experience. This is a promising method for the treatment of symptomatic patients with HOCM.

Adolescent ; Adult ; Aged ; Cardiomyopathy, Hypertrophic ; diagnostic imaging ; physiopathology ; surgery ; Echocardiography ; Electrocardiography ; Female ; Hemodynamics ; Humans ; Male ; Middle Aged

OBJECTIVETo evaluate the left ventricular (LV) radial and longitudinal systolic function in hypertrophic cardiomyopathy (HCM) patients by 3.0 T MR.

METHODSSixteen HCM (HCM group) and twenty normal adults (normal group) were examined with fast imaging employing steady-state (FIESTA) acquisition sequence of cardiac MRI. LV ejection fraction (LVEF), longitudinal shortening (LS) and fractional shortening (FS) in three standard levels were measured to analyze LV radial and longitudinal systolic function.

RESULTSAsymmetric hypertrophy was detected in all HCM patients. The LVEF and FS were significantly higher while LS was significantly lower in HCM group than those in normal group (P < 0.05 or 0.01). FS at basal and middle levels were significantly higher in HCM group than in normal group (both P < 0.01). FS in apex level was similar in the two groups (P = 0.057). Pearson correlation analysis showed that LS was negatively related with the number of hypertrophy segments in HCM patients (r = -0.537, P = 0.032). But there was no correlation between FS and the number of hypertrophy segments as well as FS and LS in HCM patients (r = -0.090, P = 0.739; r = 0.049, P = 0.856).

CONCLUSIONThe LV longitudinal systolic function was reduced but the LV radial systolic function remained unchanged in HCM patients, thus, LS changes could better reflect myocardial systolic function in HCM patients.

Adult ; Cardiomyopathy, Hypertrophic ; physiopathology ; Heart Ventricles ; Humans ; Magnetic Resonance Imaging ; Myocardium ; Systole ; Ventricular Dysfunction, Left ; Ventricular Function, Left