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European Heart Journal 1998 19(8):1261-1267; doi:10.1053/euhj.1998.0978
Copyright © 1998 by the European Society of Cardiology.
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Pattern of left ventricular filling in hypertrophic cardiomyopathy

Assessment by Doppler echocardiography and radionuclide angiography

M.A. Losia, S. Betocchiaf1, F. Manganellia, C. Briguoria, Q. Ciampia, P. Perrone-Filardia, L. Paceb, M. Salvatoreb and M. Chiarielloa

a Institute of Internal Medicine, Cardiology and Cardiac Surgery, Naples, Italy
b Institute of Radiological Sciences—Section of Nuclear Medicine, Federico II University School of Medicine, Naples, Italy

accepted January 12, 1998

Aims The left ventricle in hypertrophic cardiomyopathy is anatomically and functionally non-uniform. This study was undertaken to verify whether a heterogeneity in the pattern of diastolic filling can be detected along the left ventricular inflow tract in hypertrophic cardiomyopathy.

Methods and results Early (E) and late (A) diastolic velocities were recorded by Doppler echocardiography at mitral and at mid-ventricular level in 16 normal volunteers and 30 patients with hypertrophic cardiomyopathy. Patients with hypertrophic cardiomyopathy also underwent radionuclide angiography to assess left ventricular function. E wave decreased significantly in normal volunteers (80±15 to 60±14cm.s–1;P<0·001), but it increased in hypertrophic cardiomyopathy (76±22 to 87±28cm.s–1;P=0·04), whereas the A wave decreased similarly in both. By multivariate analysis, systolic asynchrony and the ejection fraction of left ventricular lateral wall were directly related to the pattern of early filling progression (r=0·656; F=9·467;P<0·002). Moreover, systolic asynchrony showed a univariate direct correlation with changes in E velocity (r=0·42;P=0·02).

Conclusion Many patients with hypertrophic cardio-myopathy have an acceleration of filling within the left ventricular inflow tract; this phenomenon is directly related to systolic asynchrony and ejection fraction of the left ventricular lateral wall, suggesting increased suction.

Key Words: Hypertrophic cardiomyopathy • non-uniformity • left ventricular filling

f1 Correspondence: Sandro Betocchi, MD, FESC, FACC, Department of Cardiology, Federico II University School of Medicine, Via S. Pansini, 5 I-80131 Naples, Italy.


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