INCREASED INTRAVENTRICULAR VELOCITIES - AN UNRECOGNIZED CAUSE OF SYSTOLIC-MURMUR IN ADULTS

Objectives. The purpose of this study was to determine the frequency, clinical features and echocardiographic characteristics of increased i ntraventricular velocities (Ws) in patients referred to the echocardio graphy laboratory for systolic murmur. Background. A subset of patient s referred to the echocardiography laboratory for evaluation of a syst olic murmur have Ws in the absence of other recognized causes of systo lic murmur. Methods. We prospectively studied echocardiograms from 108 consecutive patients referred for evaluation of a systolic murmur. Cl inical data were obtained from patient examinations and medical record s. Results. The sole explanation for systolic murmur was IIVs in 16.7% of referred patients. Compared with those without IIVs, patients with Ws had a higher ejection fraction (EF) (58.7 +/- 7.8% vs. 51.1 +/- 12 .5%, p < 0.001), percent fractional shortening (42.3 +/- 9.7% vs. 31.0 +/- 11.4%, p < 0.0001), left ventricular (LV) mass index (181 +/- 70 vs. 152 +/- 48 g/m(2), p = 0.046) and prevalence of hypertension (73.3 % vs. 51.7%, p = 0.043) and a lower prevalence of segmental wall motio n abnormalities (2.2% vs. 39.3%, p < 0.001). Conclusions. Increased in traventricular velocities are a common cause of systolic murmur in thi s group of patients and should be included in the differential diagnos is of systolic murmurs in adults. The association of Ws with LV hypert rophy should be a clinical consideration when these murmurs are identi fied. (J Am Coll Cardiol 1998;32:1589-95) (C)1998 by the American Coll ege of Cardiology.