Mitral valve abnormalities in hypertrophic cardiomyopathy: echocardiographic features and surgical outcomes.

BACKGROUND: Functional and intrinsic mitral valve (MV) abnormalities are common in hypertrophic cardiomyopathy (HCM); however, morphologic characteristics constituting indications for surgical intervention are incompletely defined. This study was conducted to define the echocardiographic features of MV pathology in patients with HCM and relate these to repairability of the MV, MV procedures performed, durability of repair, and survival. METHODS: From 1986 to 2003, 851 patients with HCM underwent operation, and 115 had a concomitant MV procedure. Detailed analysis of their 784 transthoracic and transesophageal echocardiograms, performed intraoperatively and postoperatively, was conducted. Outcomes were assessed by cross-sectional follow-up. RESULTS: Sixty-seven patients (58%) underwent MV repair, and 48 (42%) had MV replacement. The mean left ventricular outflow tract peak gradient was 70 +/- 50 mm Hg. Systolic anterior motion was present in 95%. Valve abnormalities were degenerative in 36 (31%), myxomatous in 23 (20%), papillary muscle in 23 (20%), restrictive chordal in 22 (19%), restrictive leaflet in 80 (70%), and long leaflet in 64 (56%). Patients undergoing MV repair had higher prevalence of long leaflets and degenerative MV pathology. The anterior mitral leaflet was 3.0 +/- 0.49 cm in the repair group vs 2.5 +/- 0.40 cm in the replacement group (p = 0.0001). MV replacement patients were older, more symptomatic, and had more renal dysfunction and lower hematocrits. By 3 years, 91% of patients with a repair were free of reoperation. CONCLUSIONS: Intrinsic MV pathology is frequently observed in HCM patients with symptomatic obstruction who undergo myectomy. Echocardiography can identify MV features predictive of successful valve repair. Repair, although durable, is feasible in only about half of patients.

Serum testosterone associates with lower high-density lipoprotein cholesterol in black and white males, 10 to 15 years of age, through lowered apolipoprotein AI and AII concentrations.

High-density lipoprotein cholesterol (HDL-C) concentrations decrease during adolescence in males in association with increasing pubertal maturation and free testosterone (F-T). To determine whether F-T effects lower HDL-C levels by decreasing the amount of cholesterol associated with the major protein moeities associated with HDL-C (apolipoprotein [apo]AI and AII) or by decreasing the concentrations of these proteins, we studied 251 black and 285 white boys, ages 10 to 15 years. In cross-sectional analysis, advancing puberty associated with decreasing HDL-C, apoAI, and apoAII in boys of each ethnic group. The decreases were greater in white (1.49 to 1.24 mmol/L) than black boys (1.68 to 1.53 mmol/L). Backward stepwise regression analyses indicated that F-T was a significant negative predictor of all 3 lipid parameters--HDL-C, apoAI, and apoAII. Ethnic group was associated with HDL-C (blacks higher) and apoAII (whites higher), but not apoAI. The ratio of HDL-C to apo (AI+AII) varied significantly (and negatively) with body mass index (BMI; kg/m(2)), but not with pubertal stage or F-T. Thus, increased F-T appears to explain decreased HDL-C via decreased apoAI and apoAII, not decreases in the amount of cholesterol associated with these proteins.