CLINICAL RESERCH: HYPERTROPHIC CARDIOMYOPATHY
Myocardial velocity gradient as a noninvasively determined index of left ventricular diastolic dysfunction in patients with hypertrophic cardiomyopathy
Tomoko Kato, MD* ,
Akiko Noda, PhD ,
Hideo Izawa, MD, PhD ,
Takao Nishizawa, MD*,
Fuji Somura, MD, PhD,
Akira Yamada, MD,
Kohzo Nagata, MD, PhD,
Mitsunori Iwase, MD, PhD, FACC,
Akimasa Nakao, MD, PhD and
Mitsuhiro Yokota, MD, PhD, FACC*,*
* Cardiovascular Division, Department of Clinical Pathophysiology, Nagoya University, Graduate School of Medicine, Nagoya, Japan
Department of Surgery II, Nagoya University, Graduate School of Medicine, Nagoya, Japan
First Department of Internal Medicine, Nagoya University, Graduate School of Medicine, Nagoya, Japan
Nagoya University School of Health Sciences, Nagoya, Japan
* Reprint requests and correspondence: Dr. Mitsuhiro Yokota, Department of Clinical Laboratory Medicine, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8560, Japan.
myokota{at}med.nagoya-u.ac.jp
OBJECTIVES: We investigated the utility of the peak negative myocardial velocity gradient (MVG) derived from tissue Doppler imaging (TDI) for evaluation of diastolic dysfunction in patients with hypertrophic cardiomyopathy (HCM).
BACKGROUND: Hypertrophic cardiomyopathy is characterized by impaired diastolic function with abnormal stiffness and prolonged relaxation. However, it remains difficult to evaluate these defects noninvasively.
METHODS: Both TDI and conventional echocardiography were performed in 36 patients with HCM and in 47 control subjects. Left ventricular (LV) pressure was measured simultaneously in all HCM patients and in 26 controls.
RESULTS: The peak negative MVG occurred soon after the isovolumic relaxation period during the initial phase of rapid filling (auxotonic relaxation). It was significantly smaller in HCM patients than in control subjects (2.32 ± 0.52/s vs. 4.82 ± 1.15/s, p < 0.0001); the cutoff value for differentiation between all HCM patients and 47 normal individuals was determined as 3.2/s. Both the left ventricular end-diastolic pressure (LVEDP) (19.6 ± 6.1 mm Hg vs. 6.5 ± 1.7 mm Hg, p < 0.0001) and the time constant of LV pressure decay during isovolumic diastole (tau) (44.0 ± 6.7 ms vs. 32.1 ± 5.5 ms, p < 0.0001) were increased in HCM patients compared with controls. The peak negative MVG was negatively correlated with both LVEDP (r = –0.75, p < 0.0001) and tau (r = –0.58, p < 0.0001).
CONCLUSIONS: A reduced peak negative MVG reflects both prolonged relaxation and elevated LVEDP. The peak negative MVG might thus provide a noninvasive index of diastolic function, yielding unique information about auxotonic relaxation in patients with HCM.
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Abbreviations and Acronyms
| | dP/dt | = first derivative of left ventricular pressure | | ECG | = electrocardiogram | | HCM | = hypertrophic cardiomyopathy | | LV | = left ventricular | | LVEDP | = left ventricular end-diastolic pressure | | MVG | = myocardial velocity gradient | | PAWP | = pulmonary artery wedge pressure | | tau | = time constant of left ventricular pressure decay | | TDI | = tissue Doppler imaging | | TD | = tau determined by the derivative method | | T1/2 | = tau determined by the pressure half-time method |
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