Hypertrophic cardiomyopathy: prevalence, hypertrophy patterns, and their clinical and ECG findings in a hospital at Qatar

Hypertrophic cardiomyopathy [HCM] is a genetic disease associated with risk of morbidity and sudden cardiac death. The prevalence, hypertrophy patterns, mode of presentations, and different ECG findings vary in different regions of the world. To date, no data is present regarding these variables in Qatar. A retrospective, cross sectional, descriptive analysis of all patients referred for echocardiography study at Hamad General Hospital, Qatar. The study period was from January 2008 till December 2010. Aims: To study 1] the prevalence of HCM, 2] the different patterns of hypertrophy, and 3] the clinical and ECG presentations in this population. Out of the 29,286 cases evaluated, 38 patients were found to have HCM [0.13%]. Their clinical, ECG, and echocardiography findings were analyzed. Mean age was 47 y, 35 males [92%] and 3 females [8%]. Four patterns of hypertrophy were described; 17 [44.7%] had septal hypertrophy alone, 6 [15.8%] had septal and other segments hypertrophy but sparing the apex, 10 [26.3%] had apical segments along with any other segment hypertrophy, and 5 [13.2%] had apical hypertrophy alone. No obstruction was found in 19 [50%], left ventricular outflow [LVO] tract obstruction was found in 13 [34%], and mid cavity obstruction [MCO] in 6 [16%]. Twenty one [55.3%] patients were referred because of chest pain, 15 [39.5%] with palpitations, 15 [39.5%] with shortness of breath, and 5 [13.2%] with syncope. Nine patients [23.7%] were asymptomatic and were referred because of cardiac murmur during routine examination. ECG evidence of LV hypertrophy was found in 29 [76.3%]. The prevalence of HCM in our population group is 0.13% with a male predominance [12:1]. There was a diversity of clinical presentation, ECG abnormalities and patterns of LV hypertrophy among HCM patients

Myocardial viability, which definition should we depend upon role of radionuclide imaging

Rest-redistribution thallium [RD T1] imaging has high negative predictive value [NPV] but low positive predictive value [PPV] for the prediction of recovery of regional myocardial dysfunction after revascularization [R]. Combining perfusion [MP] and functional data with nitrate-enhanced gazed SPECT MIBI [GSM] at rest appears to be a promising approach for viability detection. Differentiate between the role of resting TL and resting GSM for detection of viability. 66 pts with coronary artery disease [CAD] underwent T1 imaging [R-RD protocol], 2 sets of resting GSM using 2 MIBI injections, and echocardiography, both at rest and after low dose dobutamine [LDD]. One hour Before GSM2, 60 mg. of oral trimetazidine [TMZ] and nitrates had been given. All pts had their echos repeated after [R]. Perfusion and wall motion [WM] were scored from 0 to 4 [absent to normal] using 17 segment model. 385/1122 segments were found to have abnormal resting WM on echo. 165/217 of the hypokinetic segments, 48/102 of the akinetic segments and 6/66 of the dyskinetic segments showed contractile response for LDD echo. The MP images showed normal uptake, complete, partial reversibility and poor uptake in TI, GSM1 and GSM2 images as following: [54, 31, 45], [36, 22, 35], [198, 119, 190] and [32, 148, 50] of segments respectively. Following table showed degree of matching. Sensitivity and specificity of T1, GSM1 and GSM2 and LDD echo had been found respectively to be [94.9%, 75.5%], [60%, 93.6%], [94.2%, 90%] and [79.6%, 100%]. Post-revascularization Resting Echocardiography: -, -, Viable, Non-Viable, -, Viable, Non-Viable, -, Viable, Non-Viable, -, Viable, Non-Viable. Pre-revascularization: Viable- Non-Viable, Rest-Redistribution Thallium, 261- 14, 27- 83, Non-TMZ gated SPECT, 165- 110, 7- 103, TMZ gated SPECT, 259- 16, 11- 99, LDD Echocardiography, 219- 56, 0- 110. Total: -, -, 275, 110, -, 275, 110, -, 275, 110, -, 275, 110. Clinical definition of viability is better looked for in GSM2

Racial differences in left ventricular mass among hypertensive Egyptians: results from the Egyptian national hypertension project [NHP]

In this study, LV measurements were obtained from the records of 103 black [B] and 1108 non-black [NB] hypertensive [SBP >/140 and/or DBP >/90 mmHg] Egyptians who received no treatment and were age and gender matched. In B cases, the mean age was 56 years, 39% of them were males. In NB cases, age was 54 years, 43.4% were males. Left ventricular mass [LVM] was corrected for body surface area [BSA] and LVM index [LVMI]. The results of echocardiographic survey study of hypertensive Egyptians revealed that black hypertensive Egyptians have similar or even less LVMI as compared with NB in spite of the higher levels of SBP and urinary NA excretion. Data did not support the notion that black race is at especially higher risk of developing LVH

Study of pulmonary venous flow and its relation to left ventriculard filling in hypertensives

In this study, pulmonary venous flow [PVF] and LV filling [LVF] were studied by Doppler in 56 hypertensives and 15 age and gender matched controls. There was no change in systolic wave of PVF in patients compared with the controls. The diastolic wave showed a decrease in peak [KP] and mean [KM] velocities. Also, LVF in early diastole showed a decrease in peak filling velocity, while in late diastole, there was an increase in peak velocity [A]. Similarly, E/A showed a significant decrease. The decrease in KPV showed a significant linear correlation to the decrease in E/A. It was concluded that a decrease in diastolic pulmonary venous flow was detected in the hypertensives which was directly related to the impairment in LV diastolic relaxation

Improvement of left ventricular filling after short term captopril therapy in hypertensive patients

Left ventricular [LV] filling abnormalities were reported in hypertensives. To study the effect of treatment on these abnormalities we studied 12 untreated pts before [b] and after [a] short-term captopril therapy using echo-Doppler techniques. Results were compared to an age matched control group [c] of 10 individuals and are summarized in the following table: -HR [B/M]; 79 [5]; 77 [5]; 79 [5] - SBP MMHG; 126[10]; 157 [15]; 136 [10] - DBP [MMHG]; 83 [5]; 108 [12]; 83 [4] - MBP [MMHG]; 97 [6]; 125 [9]; 97 [6] - A/R RATIO; .59 [.11]; 1.1 [.21]; .59 [.11] - ACC CM-SEC2; 740 [160]; 562 [181]; 740 [161] - DEC CM-SEC2; 506 [121]; 309 [103]; 506 [121] - PFR M/SEC; 530 [134]; 437 [150]; 531 [134] - LVM GM; 205 [40]; 249 [64]; 205 [40]. R: early peak velocity. A.' late peak velocity, [A CC and DCC] acceleration and deceleration of early velocity wave, PFR: peak early filling rate computed as RX mitral annulus diameter. LVM = LV mass. Compared to CB showed a higher blood pressure, and LVM. [P < 01]. LV filling showed a higher A/R and a lower ACC and /DCC [p < 01]. After therapy there was improvement in A/R ratio and a drop in blood pressure. Other parameters did not change significantly. Drop in A/R ratio showed a correlation to the drop in DBP [6 = 0.55]. We conclude that captopril short term therapy has a potential for improving LV filling in hypertensive patients and that this improvement is related to the drop in DBP