ABSTRACT
Hypertrophic cardiomyopathy (HC) may transition to a phase characterized by systolic impairment resembling dilated cardiomyopathy. This study retrospectively assessed the incidence of left ventricular (LV) systolic impairment at initial clinical evaluation in 248 consecutive patients with HC (mean age 53 +/- 16 years). HC with systolic impairment was diagnosed if the LV ejection fraction was <50%, calculated by echocardiography. Twenty patients (8%) had HC with LV systolic impairment at initial evaluation. Patients with systolic impairment had a greater incidence of family histories of sudden cardiac death (SCD) than patients with preserved systolic function (25% vs 5.3%, p = 0.006) and more severe functional limitations (New York Heart Association class >or=III, p <0.001). All-cause mortality and cardiovascular mortality did not differ between the 2 groups. The incidence of SCD was 1.7% in patients with normal LV ejection fractions, and no SCD was observed in patients with systolic impairment. The latter group had more frequent major cardiac events (SCD, ventricular fibrillation, aborted cardiac arrest, and first implantable cardioverter-defibrillator discharge; p = 0.03). During follow-up, 2 patients progressed to HC with systolic impairment (annual incidence 0.85%). In conclusion, systolic impairment is not exceptional in patients with HC at initial evaluation and is associated with functional deterioration and major cardiac events.
Subject(s)
Cardiomyopathy, Hypertrophic/complications , Ventricular Dysfunction, Left/epidemiology , Ventricular Dysfunction, Left/physiopathology , Adolescent , Adult , Aged , Aged, 80 and over , Cardiomyopathy, Hypertrophic/epidemiology , Cardiomyopathy, Hypertrophic/physiopathology , Child , Echocardiography , Female , Follow-Up Studies , Greece/epidemiology , Humans , Incidence , Male , Middle Aged , Prevalence , Retrospective Studies , Stroke Volume , Survival Analysis , Systole , Ventricular Dysfunction, Left/etiologyABSTRACT
Left ventricular (LV) diastolic function may be affected early in patients with hypertrophic cardiomyopathy (HCM), regardless of the phenotypic expression of the disease. The aim of the present study was to detect whether LV diastolic performance, evaluated by conventional Doppler echocardiography, is impaired in first-degree relatives of patients with phenotypically expressed HCM, who had no clinical, electrocardiographic, or echocardiographic signs of the disease. Twenty-two young adults having the previously described characteristics comprised the study population and 22 sex- and age-matched healthy individuals served as controls. The 2 groups were compared according to several echocardiographic parameters and the following diastolic function indices: peak velocity of E wave, representing early filling; peak velocity of A wave, representing late filling; ratio of peak early to peak late velocity (E/A); deceleration time of E wave; and LV isovolumic relaxation time. Slower deceleration time of transmitral early filling in first-degree relatives of patients with HCM (192 +/- 31 vs 149 +/- 31 msec, p < 0.001) was the only variable that significantly differentiated the 2 groups. This study shows that in healthy persons with a family history of HCM, Doppler-derived mitral filling pattern shifted toward that observed in HCM and the slower deceleration time may serve as an early sign of disease development.
Subject(s)
Cardiomyopathy, Hypertrophic/diagnostic imaging , Cardiomyopathy, Hypertrophic/genetics , Echocardiography, Doppler , Ventricular Function, Left/physiology , Adolescent , Adult , Humans , PhenotypeABSTRACT
Diabetic cardiomyopathy is a distinct entity in diabetic patients with congestive heart failure, who have no angiographic evidence of significant coronary artery stenosis. The aim of this study was to evaluate left ventricular (LV) function in 24 elderly patients (mean age 67 +/- 2 years) with type 2 diabetes, who were asymptomatic and had no history of hypertension, or coronary or valvular heart disease. LV systolic indices (ejection fraction [EF] and fractional shortening [FS]), diastolic indices (E wave, A wave, E/A ratio, isovolumic relaxation time [IVRT] and deceleration time [DT]) and the myocardial performance index (MPI) were evaluated with echocardiography. Compared to controls (24 age- and gender-matched normal subjects), the E wave was reduced (0.60 +/- 0.10 m/sec vs 0.72 +/- 0.08 m/sec, p < 0.05), the A wave was increased (0.77 +/- 0.07 m/sec vs 0.68 +/- 0.06 m/sec, p < 0.05), the E/A ratio was decreased (0.78 +/- 0.20 vs 1.06 +/- 0.18, p < 0.001) and both IVRT and DT were prolonged (0.115 +/- 0.01 sec vs 0.09 +/- 0.01 sec, p < 0.001 and 0.240 +/- 0.04 sec vs 0.180 +/- 0.03 sec, p < 0.001, respectively). The MPI was significantly increased (0.640 +/- 0.170 vs 0.368 +/- 0.098, p < 0.001). LV diastolic function and the MPI are markedly impaired in asymptomatic elderly patients with type 2 diabetes.
Subject(s)
Diabetes Mellitus, Type 2/complications , Echocardiography , Ventricular Dysfunction, Left/diagnosis , Age Factors , Aged , Blood Glucose/analysis , Data Interpretation, Statistical , Diabetes Mellitus, Type 2/blood , Echocardiography, Doppler , Female , Glycated Hemoglobin/analysis , Heart Rate , Humans , Male , Middle Aged , Sex Factors , Ventricular Dysfunction, Left/etiologyABSTRACT
BACKGROUND AND AIM OF THE STUDY: The effect of left ventricular (LV) pressure overload on right ventricular (RV) diastolic function has been extensively studied. In contrast, no data are available concerning the influence of LV volume overload on RV diastolic function. Accordingly, RV diastolic function was studied in patients with mitral regurgitation (MR) using Doppler echocardiography. METHODS: RV diastolic indices were calculated, using pulsed Doppler echocardiography, in 30 patients (mean age 56.87 +/- 8.58 years) with severe MR, and in 30 healthy control subjects (mean age 56.67 +/- 8.52 years). RESULTS: Compared with controls, MR patients had a significantly lower RV E/A ratio (0.85 +/- 0.12 versus 1.21 +/- 0.16, p <0.001), a significantly prolonged RV isovolumic relaxation time (70 +/- 20 versus 30 +/- 10 ms, p <0.001), a significantly prolonged deceleration time of the transtricuspid E wave (210 +/- 20 versus 140 +/- 10 ms, p <0.001), and a significantly greater right atrial filling fraction (38.58 +/- 4.59 versus 32.58 +/- 3.14%, p <0.001). There was no statistically significant correlation between RV diastolic indices and LV mass index and interventricular septum thickness. CONCLUSION: RV diastolic function in patients with MR is impaired, reflecting prolonged relaxation and redistribution of RV filling into late diastole. Ventricular interdependence constitutes the most likely mechanism of this action.
Subject(s)
Diastole , Echocardiography, Doppler , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/physiopathology , Ventricular Function, Right , Adult , Aged , Electrocardiography , Humans , Middle AgedABSTRACT
Right ventricular diastolic function was evaluated using Doppler echocardiography in 40 patients with aortic regurgitation. Abnormal right ventricular relaxation and filling were the main findings of our study.
