FOCUS ISSUE: HYPERTROPHIC CARDIOMYOPATHY: STATE-OF-THE-ART PAPER
Reflections of Inflections in Hypertrophic Cardiomyopathy
Mark V. Sherrid, MD*,
Omar Wever-Pinzon, MD,
Ajay Shah, MD and
Farooq A. Chaudhry, MD
Echocardiography Laboratory and Hypertrophic Cardiomyopathy Program, Division of Cardiology, St. Luke's–Roosevelt Hospital Center, Columbia University, College of Physicians and Surgeons, New York, New York
Manuscript received February 16, 2009;
accepted March 18, 2009.
* Reprint requests and correspondence: Dr. Mark V. Sherrid, St. Luke's–Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, 1000 10th Avenue, 3B-30, New York, New York 10019 (Email: msherrid{at}chpnet.org).
The shape of Doppler velocity tracings in obstructive hypertrophic cardiomyopathy offers insights into its pathophysiology. Inflection points are the points on a curve where its shape changes from concave to convex, or vice versa. These dynamic systolic abnormalities are caused: 1) by the amplifying nature of the obstruction; and 2) by the adverse effect of the sudden imposition of afterload in midsystole. The midsystolic drop in left ventricular ejection velocities and the premature termination of longitudinal shortening are compelling evidence of the deleterious mechanical effect of obstruction on the ventricle. This dynamic systolic dysfunction, demonstrated on the Doppler curves, may contribute to heart failure symptoms and adverse outcome. In outflow obstruction, these abnormalities normalize after abolition of gradient. Therefore, their detection in an individual patient confirms obstruction as a therapeutic target.
Key Words: hypertrophic cardiomyopathy • left ventricular outflow obstruction • echocardiography • Doppler echocardiography • heart failure
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Abbreviations and Acronyms
| | HCM = hypertrophic cardiomyopathy | | LV = left ventricle/ventricular | | LVOT = left ventricular outflow tract | | SAM = systolic anterior motion of the mitral valve |
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Inside This Issue
J. Am. Coll. Cardiol. 2009 54: A24.
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