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Tandon R, Dutt S, Bansal N, Singh G, Singh B, Goyal A, Chabbra S, Aslam N, Mohan B, Wander G. Echocardiography Study of Hypertrophic Cardiomyopathy Phenotypes: An Indian Perspective. JOURNAL OF THE INDIAN ACADEMY OF ECHOCARDIOGRAPHY & CARDIOVASCULAR IMAGING 2021. [DOI: 10.4103/jiae.jiae_71_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Parato VM, Antoncecchi V, Sozzi F, Marazia S, Zito A, Maiello M, Palmiero P. Echocardiographic diagnosis of the different phenotypes of hypertrophic cardiomyopathy. Cardiovasc Ultrasound 2016; 14:30. [PMID: 27519172 PMCID: PMC4982201 DOI: 10.1186/s12947-016-0072-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 07/19/2016] [Indexed: 01/19/2023] Open
Abstract
Hypertrophic Cardiomyopathy (HCM) is an inherited cardiovascular disorder of great genetic heterogeneity and has a prevalence of 0.1 – 0.2 % in the general population. Several hundred mutations in more than 27 genes, most of which encode sarcomeric structures, are associated with the HCM phenotype. Then, HCM is an extremely heterogeneous disease and several phenotypes have been described over the years. Originally only two phenotypes were considered, a more common, obstructive type (HOCM, 70 %) and a less common, non-obstructive type (HNCM, 30 %) (Maron BJ, et al. Am J Cardiol 48:418 –28, 1981). Wigle et al. (Circ 92:1680–92, 1995) considered three types of functional phenotypes: subaortic obstruction, midventricular obstruction and cavity obliteration. A leader american working group suggested that HCM should be defined genetically and not morphologically (Maron BJ, et al. Circ 113:1807–16, 2006). The European Society of Cardiology Working Group on Myocardial and Pericardial Diseases recommended otherwise a morphological classification (Elliott P, et al. Eur Heart J 29:270–6, 2008). Echocardiography is still the principal tool for the diagnosis, prognosis and clinical management of HCM. It is well known that the echocardiographic picture may have a clinical and prognostic impact. For this reason, in this article, we summarize the state of the art regarding the echocardiographic pattern of the HCM phenotypes and its impact on clinical course and prognosis.
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Affiliation(s)
- Vito Maurizio Parato
- Cardiology Unit and EchoLab of Emergency Department, Madonna del Soccorso Hospital, Politecnica delle Marche University, 3-7, Via Manara, San Benedetto del Tronto-Ascoli Piceno, 63074, Italy.
| | | | - Fabiola Sozzi
- Cardiology Unit, University Policlinico Hospital, Milan, Italy
| | | | - Annapaola Zito
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Maria Maiello
- ASL BR, Health Center, Districtual Cardiology, Brindisi, Italy
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Guerrier K, Madueme PC, Jefferies JL, Anderson JB, Spar DS, Knilans TK, Czosek RJ. Unexpectedly low left ventricular voltage on ECG in hypertrophic cardiomyopathy. Heart 2016; 102:292-7. [PMID: 26740481 DOI: 10.1136/heartjnl-2015-308633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 12/11/2015] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE While late gadolinium enhancement (LGE) in paediatric patients with hypertrophic cardiomyopathy (HCM) is reported as similar to adults, the relationship between LGE and ECG findings in paediatric patients is unknown. We sought to evaluate the relationship between LGE on cardiac MRI and LV precordial voltage on ECG. METHODS This was a retrospective analysis of paediatric patients with HCM aged 9-21 years with cardiac MRI and ECG completed within 60 days of each other. Demographic, MRI and ECG data were compared between patients with and without LGE. Maximal diastolic septal thickness, septal to free wall ratio and LGE presence were compared with LV precordial voltage (SV1, RV6 and SV1+RV6). RESULTS This study included 37 patients (33 male). Mean age was 15.8±2.8 years. Mean maximal LV diastolic septal thickness was 22.1±7.9 mm. Mean septal to free wall ratio was 2.4±1.6 mm. LGE was present in 18 patients, with 16 isolated to the ventricular septum. Comparing patients with and without LGE, there was no difference in age (p=0.2) or body surface area (p=0.9). However, the presence of LGE was associated with significantly increased septal thickness (p=0.03), yet decreased voltages in SV1 (p=0.005), RV6 (p=0.005) and SV1+RV6 (p=0.002) despite increased septal dimensions. CONCLUSIONS A significant inverse relationship exists between LGE presence and LV precordial voltage in this population. Unexpectedly low LV precordial voltages in patients with HCM may serve as a clinical surrogate marker for myocardial fibrosis and potential loss of viable myocardial tissue.
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Affiliation(s)
- Karine Guerrier
- Department of Cardiology, Cincinnati Children's Hospital Medical Center, The Heart Institute, Cincinnati, Ohio, USA
| | - Peace C Madueme
- Department of Cardiology, Cincinnati Children's Hospital Medical Center, The Heart Institute, Cincinnati, Ohio, USA
| | - John L Jefferies
- Department of Cardiology, Cincinnati Children's Hospital Medical Center, The Heart Institute, Cincinnati, Ohio, USA
| | - Jeffrey B Anderson
- Department of Cardiology, Cincinnati Children's Hospital Medical Center, The Heart Institute, Cincinnati, Ohio, USA
| | - David S Spar
- Department of Cardiology, Cincinnati Children's Hospital Medical Center, The Heart Institute, Cincinnati, Ohio, USA
| | - Timothy K Knilans
- Department of Cardiology, Cincinnati Children's Hospital Medical Center, The Heart Institute, Cincinnati, Ohio, USA
| | - Richard J Czosek
- Department of Cardiology, Cincinnati Children's Hospital Medical Center, The Heart Institute, Cincinnati, Ohio, USA
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Guerrier K, Anderson JB, Pratt J, King EC, Statile C, Wilmot I, Campbell M, Czosek RJ. Correlation of precordial voltages to left ventricular mass on echocardiogram in adolescent patients with hypertrophic cardiomyopathy compared with that in adolescent athletes. Am J Cardiol 2015; 115:956-61. [PMID: 25670640 DOI: 10.1016/j.amjcard.2015.01.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 01/06/2015] [Accepted: 01/06/2015] [Indexed: 01/12/2023]
Abstract
Electrocardiograms continue to be part of screening programs for athletes and familial hypertrophic cardiomyopathy (HC). Whether electrocardiographic (ECG) findings of left ventricular (LV) hypertrophy can distinguish between healthy populations and those with HC remains unclear. We sought to (1) analyze the relation between ECG voltage and LV mass in patients with HC and (2) evaluate ECG characteristics of patients with phenotypical HC. Retrospective cohort of patients with HC aged 13 to 18 years. Relation between ECG voltages (RV6, SV1, and RV6 + SV1) and echocardiogram measurements of LV mass was investigated using smoothing splines to display relations and compared with those in a prospectively obtained population of adolescents. Frequency of abnormal LV voltages and nonvoltage ECG changes (Q waves, T-wave changes, and ST changes) were analyzed for association with HC. Fifty-three patients with HC (72% men) were age and gender matched to 104 control patients. Smoothing splines demonstrated that parabolic rather than linear relations existed between LV mass and SV1, RV6, and RV6 + SV1 in patients with HC and not the control cohort. LV hypertrophy by ECG voltage criteria was present in 34% of patients with HC and associated with poor sensitivity (29%). In patients with HC, 56% demonstrated nonvoltage ECG abnormalities and were associated with improved sensitivity (68%) and high specificity (94%). In conclusion, there is a parabolic relation between LV voltages and LV mass in adolescents with HC that may lead to "pseudonormalization." Voltage abnormalities were associated with poor sensitivity, whereas nonvoltage criteria were associated with improved sensitivity with high specificity.
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Affiliation(s)
- Karine Guerrier
- Department of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Jeffrey B Anderson
- Department of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jesse Pratt
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Eileen C King
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Christopher Statile
- Department of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ivan Wilmot
- Department of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Matthew Campbell
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Richard J Czosek
- Department of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Vatan MB, Gunduz H, Gurel S, Kocayigit I, Vural A, Demirtas S, Cakar MA, Gunduz Y. An Unusual Type of Localized Hypertrophic Cardiomyopathy With Wolf Parkinson White Syndrome Presenting With Pulmonary Edema. Cardiol Res 2012; 3:133-136. [PMID: 28352409 PMCID: PMC5358242 DOI: 10.4021/cr138w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2012] [Indexed: 11/04/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is an autosomal dominant heart disease that is the most common genetic cardiac disorder. The disease is characterized by excessive thickening of the left ventricular myocardium. The anterior portion of the interventricular ventricular septum is often involved. Asymmetric hypertrophy of apical site, left ventricular free wall, and right ventricle are less common in hypertrophic cardiomyopathy that occur in 1% cases. We report a case of a patient with an unusual type of hypertrophic cardiomyopathy and Wolf Parkinson White (WPW) presenting with pulmonary edema.
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Affiliation(s)
- Mehmet Bulent Vatan
- Sakarya University, Medical faculty, Deparmet of Cardiology, Sakarya, Turkey
| | - Huseyin Gunduz
- Sakarya University, Medical faculty, Deparmet of Cardiology, Sakarya, Turkey
| | - Safiye Gurel
- Abant izzet Baysal University Bolu Medical faculty, Deparmet of Radiology, Bolu, Turkey
| | - Ibrahim Kocayigit
- Sakarya University, Medical faculty, Deparmet of Cardiology, Sakarya, Turkey
| | - Ahmet Vural
- Kocaeli University, Medical faculty, Deparmet of Cardiology, Kocaeli, Turkey
| | - Saadet Demirtas
- Sakarya University, Medical faculty, Deparmet of Cardiology, Sakarya, Turkey
| | - Mehmet Akif Cakar
- Sakarya University, Medical faculty, Deparmet of Cardiology, Sakarya, Turkey
| | - Yasemin Gunduz
- Sakarya University, Medical faculty, Deparmet of Radiology, Sakarya, Turkey
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Abstract
Hypertrophic cardiomyopathy (HCM) is characterized by inappropriate left ventricular hypertrophy (LVH) in the setting of a nondilated left ventricle. HCM is often associated with asymmetric LVH, a family history of HCM, sarcomeric genetic mutations, and an increased risk of sudden cardiac death. There is a wide clinical variability in HCM presenting during childhood and a relative lack of data on the pediatric population. This review will cover HCM presenting in infancy, childhood, and adolescence.
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Affiliation(s)
- Shiraz A Maskatia
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, USA.
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Maron BJ, Sherrid MV, Haas TS, Lindberg J, Kitner C, Lesser JR. Novel hypertrophic cardiomyopathy phenotype: segmental hypertrophy isolated to the posterobasal left ventricular free wall. Am J Cardiol 2010; 106:750-2. [PMID: 20723657 DOI: 10.1016/j.amjcard.2010.04.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 04/20/2010] [Accepted: 04/20/2010] [Indexed: 11/28/2022]
Abstract
Few other diseases show the degree of phenotypic heterogeneity expressed by HC. The two novel patients reported here with isolated posterobasal LV free wall hypertrophy (and mitral valve prolapse) extend this morphologic diversity even farther, now 3 decades after the introduction of contemporary 2-dimensional imaging.
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Affiliation(s)
- Barry J Maron
- Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minnesota, USA.
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Biagini E, Coccolo F, Ferlito M, Perugini E, Rocchi G, Bacchi-Reggiani L, Lofiego C, Boriani G, Prandstraller D, Picchio FM, Branzi A, Rapezzi C. Dilated-Hypokinetic Evolution of Hypertrophic Cardiomyopathy. J Am Coll Cardiol 2005; 46:1543-50. [PMID: 16226182 DOI: 10.1016/j.jacc.2005.04.062] [Citation(s) in RCA: 149] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2005] [Revised: 04/20/2005] [Accepted: 04/25/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study sought to investigate the incidence, risk factors, and prognosis of dilated-hypokinetic evolution in a large cohort of patients with hypertrophic cardiomyopathy (HCM) followed up at a cardiology center serving both the pediatric and the adult population. BACKGROUND The available data on this evolution of HCM mainly regards prevalence (rather than incidence) in adults, with very little being known about the pediatric population. METHODS A total of 222 consecutive HCM patients (65% men, 19% < or =18 years old) were prospectively evaluated for a mean follow-up of 11 +/- 9 years. RESULTS A diagnosis of dilated-hypokinetic HCM was made in 12 patients at first evaluation (11 without previous septal myectomy surgery; prevalence, 4.9%). Twelve of the 210 patients with classic HCM at first evaluation underwent dilated-hypokinetic evolution (incidence, 5.3/1,000 patient-years). Patients with prevalent/incident dilated-hypokinetic evolution were younger at first evaluation (32 +/- 14 years vs. 41 +/- 21 years, p = 0.04) and more often had a family history of HCM (61% vs. 26%, p = 0.002) or sudden death (43% vs. 19%, p = 0.01) with respect to patients who maintained classic HCM. Moreover, they showed greater interventricular septum (23 +/- 3 mm vs. 19 +/- 6 mm, p = 0.004) and posterior wall (15 +/- 3 mm vs. 13 +/- 4 mm, p = 0.006) thickness. Cardiovascular death-free survival was lower among patients with dilated-hypokinetic HCM (p < 0.04). Cox proportional hazards regression analysis identified left ventricular wall thickness (hazard ratio [HR] = 1.07; 95% confidence interval [CI], 1.01 to 1.14; p = 0.03) and end-diastolic diameter (HR = 1.08; 95% CI 1.04 to 1.11; p = 0.0001) as independent predictors of cardiovascular death. CONCLUSIONS Dilated-hypokinetic evolution is rare but not exceptional in HCM. Young age at diagnosis, family history of HCM, and greater wall thickness are incremental risk factors for dilated-hypokinetic HCM, which carries an ominous prognosis.
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Affiliation(s)
- Elena Biagini
- Institute of Cardiology, University of Bologna, Bologna, Italy
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Affiliation(s)
- G N Prah
- Department of Anesthesiology, Albany Medical Center, NY 12208-3478, USA
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Romero-Farina G, Candell-Riera J, Pereztol-Valdés O, Galve-Basilio E, Palet-Balart J, García Del Castillo H, Aguadé-Bruix S, Castell-Conesa J, Ortega-Alcalde D, Soler-Soler J. [Morphologic classification of hypertrophic cardiomyopathy with myocardial single photon emission tomography. Comparison with echocardiographic classification]. Rev Esp Cardiol 2000; 53:511-6. [PMID: 10758028 DOI: 10.1016/s0300-8932(00)75121-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES The aim of this study was to compare different morphologic types of hypertrophic cardiomyopathy obtained by single photon emission tomography to those obtained by echocardiogram. MATERIALS AND METHODS In 76 (64%) out of 119 patients with hypertrophic cardiomyopathy the echocardiogram permitted an optimal visualization of all left ventricular segments in the short axis view and consequent classification to one of the six morphological types: type I (septal anterior hypertrophy), type II (septal anterior and septal posterior hypertrophy), type III (septal and antero-lateral hypertrophy), type IV (antero-lateral and/or septal posterior hypertrophy), type V (concentric hypertrophy) and type VI (apical hypertrophy). Without knowledge of echo data, two experienced observers included the short axis of single photon emission tomography images at rest (99mTc-tetrofosmin) to one of those types. RESULTS Global concordance between echocardiogram and single photon emission tomography was 75%. Type III was the most frequent both in echo (76%) and in single photon emission tomography (74%) and type III produced the majority of discrepancies. SPET identified 4 patients with a predominant septal and inferior hypertrophy, that did not correspond to any of the 6 types of echocardiographic classification and had been previously classified as type III by echo in 3 cases and as type V in 1 case. CONCLUSIONS There was agreement between echo and single photon emission tomography in the morphological classification of most of the patients (75%) with hypertrophic cardiomyopathy. Nevertheless, some discrepancies were observed for the type III echocardiogram.
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Affiliation(s)
- G Romero-Farina
- Servicio de Cardiología. Hospital General Universitari Vall d'Hebron. Barcelona
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Kobashi A, Suwa M, Ito T, Otake Y, Hirota Y, Kawamura K. Solitary papillary muscle hypertrophy as a possible form of hypertrophic cardiomyopathy. JAPANESE CIRCULATION JOURNAL 1998; 62:811-6. [PMID: 9856596 DOI: 10.1253/jcj.62.811] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patients can present with hypertrophied papillary muscles in the left ventricle, even without hypertrophy in other segments, and they have electrocardiographic (ECG) abnormalities suggestive of hypertrophic cardiomyopathy (HCM). This study was performed to evaluate whether the solitary papillary muscle hypertrophy was related to HCM. By analyzing 6731 echocardiographic studies between 1990 and 1994, the incidence of patients with papillary muscle hypertrophy was retrospectively examined, as well as the ECG features and family history related to HCM in these patients. After the normal size of the anterolateral and posteromedial papillary muscles was obtained from echocardiographic studies in 40 healthy subjects (0.7 +/- 0.2 cm for each of the vertical and horizontal axis), papillary muscle hypertrophy was defined as follows: either the vertical or horizontal diameter of at least one of the 2 papillary muscles was more than 1.1 cm (mean+2SD in the normal subjects). Using this definition, 29 patients with papillary muscle hypertrophy were identified, of whom 14 (48%) showed high voltage QRS complexes, 10 (34%) showed T wave inversion, and 6 (21%) showed abnormal Q waves. Ten patients (34%) had a family history of HCM. In 2 patients that were followed for 18 and 11 years, respectively, the voltages of the QRS complexes and inverted T waves progressed with the hypertrophy of the papillary muscle. These findings suggest that solitary papillary muscle hypertrophy is related to HCM and that papillary muscle hypertrophy is a newly identified subtype of or an early form of HCM.
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Affiliation(s)
- A Kobashi
- The Third Division, Department of Internal Medicine, Osaka Medical College, Takatsuki City, Japan
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Klues HG, Schiffers A, Maron BJ. Phenotypic spectrum and patterns of left ventricular hypertrophy in hypertrophic cardiomyopathy: morphologic observations and significance as assessed by two-dimensional echocardiography in 600 patients. J Am Coll Cardiol 1995; 26:1699-708. [PMID: 7594106 DOI: 10.1016/0735-1097(95)00390-8] [Citation(s) in RCA: 410] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES This study sought to achieve an understanding of the true structural heterogeneity of hypertrophic cardiomyopathy. BACKGROUND The diversity and clinical significance of the morphologic expression of hypertrophic cardiomyopathy have not been fully defined within this broad disease spectrum. METHODS Patterns of left ventricular hypertrophy were characterized by two-dimensional echocardiography in a large study cohort of 600 patients (7 to 79 years old, mean age 45; 393 [66%] men) consecutively studied at two referral centers. RESULTS Left ventricular wall thickness was 15 to 52 mm (mean [+/- SD] 22.3 +/- 5). A multitude of patterns of asymmetric left ventricular hypertrophy were identified, with the most common showing diffuse involvement of substantial portions of both ventricular septum and free wall. Of 16 possible patterns of left ventricular hypertrophy, 12 (78%) were identified among the 600 patients. Hypertrophy most commonly involved two left ventricular segments (228 patients [38%]) or three or more segments (202 patients [34%]), but was also localized to one segment in a substantial number of patients (170 [28%]). The anterior portion of the ventricular septum was the region of the left ventricle that most frequently showed thickening (573 patients [96%]), and was also the predominant site of hypertrophy in most patients (492 patients [83%]). Patterns of wall thickening that were either concentric (i.e., symmetric) or confined to the apex were particularly uncommon (in 1% each). CONCLUSIONS 1) In hypertrophic cardiomyopathy, the distribution of left ventricular hypertrophy is characteristically asymmetric and particularly heterogeneous, encompassing most possible patterns of wall thickening, from extensive and diffuse to mild and segmental, and with no single morphologic expression considered typical or classic. 2) A greater extent of left ventricular hypertrophy was associated with younger age and more marked mitral valve systolic anterior motion and outflow obstruction but showed no relation to either magnitude of symptoms or gender.
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Affiliation(s)
- H G Klues
- Department of Cardiology, University Hospital Rheinisch-Westfälische Technische Hochschule, Aachen, Germany
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Affiliation(s)
- E K Louie
- Department of Medicine, Loyola University Medical Center, Maywood 60153
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Affiliation(s)
- B J Maron
- Cardiovascular Research Division, Minneapolis Heart Institute Foundation, Minnesota
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Abstract
The original classifications of the cardiomyopathies based on anatomic criteria from radiographic and necropsy studies, as well as hemodynamic criteria from clinical and catheterization data, have been supplemented in recent years by information from noninvasive techniques. Echocardiography, radionuclide methods, and ambulatory ECG, in particular, have facilitated the ethical screening of family members and those less symptomatic than patients on whom the original classification was based. These powerful methods show a broad spectrum of anatomy and ventricular physiology along the natural history of and within the traditional categories of the cardiomyopathies. They also provide data on the effect of ventricular loading conditions affecting a range of diastolic filling patterns. This review has attempted to point out the areas of overlap among and/or controversy about the categories that have led us to a feeling of frustration when trying to neatly classify individual patients. The addition of filling patterns from Doppler echocardiography and nuclear angiography to the standard methods has been reviewed and hopefully will lend more perspective to the range of physiology seen in these conditions. The categories of cardiomyopathy should not be seen as excluding patients with the newly recognized variations in anatomy and ventricular filling patterns. Rather, the classification provides a framework on which to build and expand our understanding of these important conditions.
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Affiliation(s)
- A Keren
- Heiden Department of Cardiology, Bikur Cholim Hospital, Jerusalem, Israel
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