Circulation, Vol 90, 186-194, Copyright © 1994 by American Heart Association
CM Kramer, N Reichek, VA Ferrari, T Theobald, J Dawson and L Axel
BACKGROUND: In patients with hypertrophic cardiomyopathy (HCM), left
ventricular ejection performance may be normal while segmental myocardial
function is distinctly abnormal. The advent of magnetic resonance tissue
tagging has allowed the noninvasive evaluation of intramyocardial segmental
shortening in vivo in a topographic and temporal manner. METHODS AND
RESULTS: Ten patients with HCM documented by echocardiography and 10
healthy volunteers were studied with magnetic resonance tissue tagging by
spatial modulation of magnetization. Percent circumferential myocardial
shortening (%S) was compared at endocardium, midwall, and epicardial levels
at four regions around the left ventricular short axis and from four short
axis slices from apex to base at four or five time intervals during
systole. In 8 patients and 8 control subjects, longitudinal shortening was
evaluated within the septum and the lateral free wall at three levels from
apex to base. Circumferential %S was less in HCM patients than in control
subjects in the septal (13 +/- 5% versus 24 +/- 6%, P = .0002), inferior
(13 +/- 5% versus 21 +/- 4%, P = .001), and anterior (17 +/- 5% versus 21
+/- 3%, P < .03) regions but not in the lateral region. Circumferential
end-systolic %S was reduced in patients with HCM compared with control
subjects at all levels from apex to base. The normal transmural gradient in
circumferential end-systolic shortening was preserved with greatest %S at
the endocardium. Most of the total cumulative circumferential shortening
occurred earlier in systole in patients compared with control subjects,
especially within the septum. Longitudinal end-systolic %S was depressed
throughout the septum in patients compared with control subjects, most
markedly at the base, but was normal in the lateral free wall. CONCLUSIONS:
Circumferential myocardial segment shortening is depressed in HCM in the
septum, inferior, and anterior regions and at all levels from apex to base,
and much of the total cumulative shortening occurs early in systole.
Longitudinal shortening is reduced in the basal septum in HCM. The
heterogeneity of regional function in these patients may reflect the
regional variation in the myocardial disarray and fibrosis that is
characteristic of this disorder.
ARTICLES
Regional heterogeneity of function in hypertrophic cardiomyopathy
Division of Cardiology, Medical College of Pennsylvania, Allegheny General Hospital, Pittsburgh 15212.
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