Circulation, Vol 88, 2206-2214, Copyright © 1993 by American Heart Association
S Betocchi, OM Hess, MA Losi, H Nonogi and HP Krayenbuehl
BACKGROUND: Nonuniformity is a determinant of diastolic function. In
patients with hypertrophic cardiomyopathy, hypertrophy, abnormal calcium
handling, and regional ischemia can also play a role. This study was
designed to assess regional mechanics, asynchrony, and asynergy in patients
with hypertrophic cardiomyopathy. METHODS AND RESULTS. Nine control
subjects and 22 patients with hypertrophic cardiomyopathy were studied by
biplane left ventriculography and high- fidelity pressure tracings for the
assessment of diastolic function by computing the time constant of
isovolumic relaxation, peak filling rate, and the constant of passive
chamber stiffness. Regional mechanics were evaluated by dividing the left
ventricle into six sectors in the right and left anterior oblique
projections. Systolic and diastolic asynchrony were assessed from the
coefficient of variation of the regional time intervals from end diastole
to end systole and to peak filling rate, respectively. Asynergy was
evaluated from the coefficient of variation of the regional area reduction.
Regional passive elastic properties were estimated by computing the
regional constant of chamber stiffness. In patients with hypertrophic
cardiomyopathy, isovolumic relaxation was prolonged (time constant of
isovolumic relaxation 101 +/- 41 versus 51 +/- 16 milliseconds in control
subjects; P < .001) and the constant of chamber stiffness was increased
(0.056 +/- 0.038 versus 0.025 +/- 0.010 mL-1; P < .001). Both systolic
and diastolic asynchrony as well as asynergy were found. Regional mechanics
showed hyperkinesia in the free wall, whereas the septum exhibited normal
wall motion and increased constant of chamber stiffness. CONCLUSIONS.
Diastolic function is impaired in hypertrophic cardiomyopathy, and such an
impairment is the consequence of nonuniformity and hypertrophy. The regions
where the myopathic process is more pronounced show normal wall motion but
increased stiffness. The inhomogeneity of regional wall motion with
regional hyperkinesia and normokinesia of neighboring regions results in
left ventricular asynergy.
ARTICLES
Regional left ventricular mechanics in hypertrophic cardiomyopathy
Division of Cardiology, University Hospital, Zurich, Switzerland.
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