Progression of hypertrophic cardiomyopathy into a hypokinetic left ventricle: higher incidence in patients with midventricular obstruction

The development of segmental or generalized left ventricular hypokinesia is an unusual occurrence in patients with hypertrophic cardiomyopathy. To determine the incidence and possible pathophysiologic mechanisms responsible for this process, the serial clinical and laboratory data of 62 patients with the diagnosis of hypertrophic cardiomyopathy were analyzed. During a mean follow-up period of 8 years (range 2 to 21), 5 patients (Group A) developed left ventricular hypokinesia, whereas the remaining 57 patients (Group B) continued to exhibit the clinical and laboratory findings of hypertrophic cardiomyopathy. Three patients developed a dilated left ventricle with generalized hypokinesia; two other patients had segmental left ventricular wall motion abnormalities. None of these five patients who developed left ventricular hypokinesia had fixed coronary artery disease. The mean age, sex, mean duration of follow-up, presence of coronary myocardial bridges and angina pectoris, and an interventricular gradient were all similar in Groups A and B. Midventricular obliteration was seen in 4 (80%) of the 5 patients in Group A and in 4 (7%) of the 57 patients in Group B (p less than 0.001). Findings from this study reveal that segmental or generalized left ventricular hypokinesia can develop in patients with hypertrophic cardiomyopathy in the absence of fixed coronary artery disease. Such hypokinesia can occur after an acute myocardial infarction or it can develop gradually without clinical or electrocardiographic evidence of infarction. Patients with the mid-ventricular obliteration variant of hypertrophic cardiomyopathy are at a higher risk of developing segmental or diffuse left ventricular hypokinesia.

This article has been cited by other articles:

				Y. Minami, K. Kajimoto, Y. Terajima, B. Yashiro, D. Okayama, S. Haruki, T. Nakajima, N. Kawashiro, M. Kawana, and N. Hagiwara Clinical Implications of Midventricular Obstruction in Patients With Hypertrophic Cardiomyopathy J. Am. Coll. Cardiol., June 7, 2011; 57(23): 2346 - 2355. [Abstract] [Full Text] [PDF]

				E. J. Chun, S. I. Choi, K. N. Jin, H. J. Kwag, Y. J. Kim, B. W. Choi, W. Lee, and J. H. Park Hypertrophic Cardiomyopathy: Assessment with MR Imaging and Multidetector CT RadioGraphics, September 1, 2010; 30(5): 1309 - 1328. [Abstract] [Full Text] [PDF]

				S Basavarajaiah, M Siam, and S Sharma Unusual cause of stroke in hypertrophic cardiomyopathy Heart, October 1, 2009; 95(19): 1592 - 1592. [Full Text] [PDF]

				B. J. Maron, M. S. Maron, E. D. Wigle, and E. Braunwald The 50-Year History, Controversy, and Clinical Implications of Left Ventricular Outflow Tract Obstruction in Hypertrophic Cardiomyopathy: From Idiopathic Hypertrophic Subaortic Stenosis to Hypertrophic Cardiomyopathy J. Am. Coll. Cardiol., July 14, 2009; 54(3): 191 - 200. [Abstract] [Full Text] [PDF]

				M. V. Sherrid, O. Wever-Pinzon, A. Shah, and F. A. Chaudhry Reflections of Inflections in Hypertrophic Cardiomyopathy J. Am. Coll. Cardiol., July 14, 2009; 54(3): 212 - 219. [Abstract] [Full Text] [PDF]

				M. S. Maron, J. J. Finley, J. M. Bos, T. H. Hauser, W. J. Manning, T. S. Haas, J. R. Lesser, J. E. Udelson, M. J. Ackerman, and B. J. Maron Prevalence, Clinical Significance, and Natural History of Left Ventricular Apical Aneurysms in Hypertrophic Cardiomyopathy Circulation, October 7, 2008; 118(15): 1541 - 1549. [Abstract] [Full Text] [PDF]

				K. M. Harris, P. Spirito, M. S. Maron, A. G. Zenovich, F. Formisano, J. R. Lesser, S. Mackey-Bojack, W. J. Manning, J. E. Udelson, and B. J. Maron Prevalence, Clinical Profile, and Significance of Left Ventricular Remodeling in the End-Stage Phase of Hypertrophic Cardiomyopathy Circulation, July 18, 2006; 114(3): 216 - 225. [Abstract] [Full Text] [PDF]

				E. Biagini, F. Coccolo, M. Ferlito, E. Perugini, G. Rocchi, L. Bacchi-Reggiani, C. Lofiego, G. Boriani, D. Prandstraller, F. M. Picchio, et al. Dilated-Hypokinetic Evolution of Hypertrophic Cardiomyopathy: Prevalence, Incidence, Risk Factors, and Prognostic Implications in Pediatric and Adult Patients J. Am. Coll. Cardiol., October 18, 2005; 46(8): 1543 - 1550. [Abstract] [Full Text] [PDF]

				M. Hamada, Y. Shigematsu, K. Ohshima, J. Suzuki, A. Ogimoto, T. Ohtsuka, and Y. Hara Diagnostic Usefulness of Carotid Pulse Tracing in Patients With Hypertrophic Obstructive Cardiomyopathy Due to Midventricular Obstruction: A Comparison With Idiopathic Hypertrophic Subaortic Stenosis Chest, October 1, 2003; 124(4): 1275 - 1283. [Abstract] [Full Text] [PDF]

				E. D. Wigle, H. Rakowski, B. P. Kimball, and W. G. Williams Hypertrophic Cardiomyopathy : Clinical Spectrum and Treatment Circulation, October 1, 1995; 92(7): 1680 - 1692. [Full Text]