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European Heart Journal 1999 20(4):293-302; doi:10.1053/euhj.1998.1274
Copyright © 1999 by the European Society of Cardiology.
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Pulmonary venous flow in hypertrophic cardiomyopathy as assessed by the transoesophageal approach

The additive value of pulmonary venous flow and left atrial size variables in estimating the mitral inflow pattern in hypertrophic cardiomyopathy

E.G. Torrecillaf1, M.A. García Fernández, H. Bueno, M. Moreno and J.L. Delcán

Cardiology Department, Hospital General Universitario "Gregorio Marañón" Madrid, Spain

Received May 21, 1998; accepted July 22, 1998

Abstract

Aims This study was conducted to assess the characteristics of the pattern of pulmonary venous flow and to document the interaction of this flow and left atrial function with the pattern of mitral inflow in hypertrophic cardiomyopathy.

Methods and Results Pulmonary venous and mitral flows were evaluated by the transoesophageal approach in 80 patients with hypertrophic cardiomyopathy. Left atrial size and function were measured by the transthoracic approach. Their values were compared with those obtained from 35 normal controls. Twelve patients showed significant (>2+) mitral regurgitation. As a group, hypertrophic cardio-myopathy patients showed increased atrial reversal flow and longer deceleration time of the diastolic wave, but a wide variability of pulmonary venous flow patterns were observed. Thirty patients (37·5%) had pseudonormal mitral flow patterns. Stepwise multilinear regression analysis identified the ratio of systolic to diastolic pulmonary venous flow velocity, the ratio of velocity-time integrals of both flow waves at atrial contraction, the left atrial minimal volume and the systolic fraction as independent predictive variables of the mitral E/A wave velocity ratio (r=0·82). By logistic regression, the former three variables were selected as independent predictive covariates of a pseudonormal mitral flow pattern (sensitivity: 83%, specificity: 90%). The ratio of velocity-time integrals of both atrial waves was the most important predictive variable in both analyses.

Conclusions The observed variability in the configuration of pulmonary venous flow velocity waveform is related to what occurs in transmitral flow in patients with hypertrophic cardiomyopathy. Significant mitral regurgitation is not an independent correlate of pseudonormal mitral inflow patterns in these patients. Our results further emphasize the complementary, additive value of the pulmonary venous flow velocity pattern and left atrial size in the interpretation of the mitral flow velocity pattern, and indirectly suggest the underlying increased left ventricular filling pressures of patients with hypertrophic cardiomyopathy and pseudonormal mitral flow patterns.

Key Words: Diastolic function • hypertrophic cardio-myopathy • pulmonary venous flow • transoesophageal echocardiography

f1 Correspondence: Esteban G. Torrecilla, MD, Cardiology Department, Hospital General Universitario "Gregorio Marañón", C/. Doctor Esquerdo 46, Madrid 28007, Spain.

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