PATTERN OF LEFT-VENTRICULAR FILLING IN HYPERTROPHIC CARDIOMYOPATHY - ASSESSMENT BY DOPPLER-ECHOCARDIOGRAPHY AND RADIONUCLIDE ANGIOGRAPHY

Aims The left ventricle in hypertrophic cardiomyopathy is anatomically and functionally non-uniform. This study was undertaken to verify whe ther a heterogeneity in the pattern of diastolic filling can be detect ed along the left ventricular inflow tract in hypertrophic cardiomyopa thy. Methods and Results Early (E) and late (A) diastolic velocities w ere recorded by Doppler echocardiography at mitral and at mid-ventricu lar level in 16 normal volunteers and 30 patients with hypertrophic ca rdiomyopathy. Patients with hypertrophic cardiomyopathy also underwent radionuclide angiography to assess left ventricular function. E wave decreased significantly in normal volunteers (80 +/- 15 to 60 +/- 14 c m.s(-1); P < 0.001), but it increased in hypertrophic cardiomyopathy ( 76 +/- 22 to 87 +/- 28 cm.s(-1); P = 0.04), whereas the A wave decreas ed similarly in both. By multivariate analysis, systolic asynchrony an d the ejection fraction of left ventricular lateral wall were directly related to the pattern of early filling progression (r = 0.656; F = 9 .467; P < 0.002). Moreover, systolic asynchrony showed a univariate di rect correlation with changes in E velocity (r = 0.42; P = 0.02). Conc lusion Many patients with hypertrophic cardiomyopathy have an accelera tion of filling within the left ventricular inflow tract; this phenome non is directly related to systolic asynchrony and ejection fraction o f the left ventricular lateral wall, suggesting increased suction.