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European Heart Journal Advance Access originally published online on December 19, 2005
European Heart Journal 2006 27(11):1311-1318; doi:10.1093/eurheartj/ehi688
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Prognostic value of intra-left ventricular electromechanical asynchrony in patients with hypertrophic cardiomyopathy{dagger}

Antonello D'Andrea1,*, Pio Caso2, Sergio Severino2, Sergio Cuomo1, Giovanbattista Capozzi1, Paolo Calabrò1, Gennaro Cice1, Luigi Ascione3, Marino Scherillo4 and Raffaele Calabrò1

1 Chair of Cardiology, Second University of Naples, Via G. Martucci 35, 80121 Naples, Italy
2 Department of Cardiology, Monaldi Hospital, Naples, Italy
3 Department of Cardiology, Santa Maria di Loreto Hospital, Naples, Italy
4 Departmentof Interventional Cardiology, Rummo Hospital, Benevento, Italy

Received 22 July 2005; revised 13 November 2005; accepted 24 November 2005; online publish-ahead-of-print 19 December 2005.

* Corresponding author. Tel: +39 081 7618525; Fax: +39 081 7145205. E-mail address: adandrea{at}napoli.com

Aims We sought to assess the indexes of myocardial activation delay, using Doppler myocardial imaging (DMI), as potential predictors of cardiac events in patients with hypertrophic cardiomyopathy (HCM). The distribution and magnitude of left ventricular (LV) hypertrophy are not uniform in patients with HCM, which results in heterogeneity of regional LV systolic function.

Methods and results The study population included 123 HCM patients (39.4±5.9 years) and 123 age- and sex-matched healthy subjects, followed up for 48.4±8.8 months. By use of pulsed DMI, the following regional parameters were evaluated in six different basal myocardial segments: myocardial peak velocities and systolic time-intervals; myocardial intraventricular (intra-V-Del) and interventricular (inter-V-Del) systolic delays. DMI analysis in HCM showed lower myocardial systolic and early-diastolic peak velocities of all the segments. As for time intervals, HCM showed significant inter- and intra-V delays (P<0.0001), whereas homogeneous systolic activation of the ventricular walls was assessed in controls. During the follow-up, 16 cardiac deaths (12 sudden deaths) were observed in HCM patients. InHCM, DMI intra-V-Del was the most powerful independent predictor of sudden cardiac death (P<0.0001). In particular, an intra-V-Del >45 ms is identified with high sensitivity and specificity in HCM patients at higher risk of ventricular tachycardia and sudden cardiac death (test accuracy: 88.8%).

Conclusion In HCM patients, DMI indexes of intra-V-Del may provide additional information for selecting subgroups of HCM patients at increased risk of ventricular arrhythmias and sudden cardiac death at follow-up. Accordingly, such patients may be more actively identified for early intensive treatment and survey.

Key Words: Doppler myocardial imaging • Hypertrophic cardiomyopathy • Intra-ventricular delay • Arrhythmias • Prognosis • Sudden cardiac death


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