Published Online
on December 6, 2004

A more recent version of this article appeared on December 21, 2004

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Submitted on April 19, 2004
Revised on September 14, 2004
Accepted on September 24, 2004

Discrimination of Nonobstructive Hypertrophic Cardiomyopathy From Hypertensive Left Ventricular Hypertrophy on the Basis of Strain Rate Imaging by Tissue Doppler Ultrasonography

Tomoko S. Kato MD, PhD, Akiko Noda PhD, Hideo Izawa MD, PhD, Akira Yamada MD, Koji Obata PhD, Kohzo Nagata MD, PhD, Mitsunori Iwase MD, PhD, Toyoaki Murohara MD, PhD, and Mitsuhiro Yokota MD, PhD^*

From the Department of Clinical Pathophysiology (T.S.K., K.O., M.Y.) and Department of Cardiology (T.S.K., H.I., A.Y., T.M.), Nagoya University, Graduate School of Medicine, and Nagoya University School of Health Sciences (A.N., K.N., M.I.), Nagoya, Japan.

^* To whom correspondence should be addressed. E-mail: myokota{at}med.nagoya-u.ac.jp.

Background--The differentiation of hypertrophic cardiomyopathy (HCM) from hypertensive left ventricular hypertrophy (H-LVH) on the basis of morphological information obtained by conventional echocardiography is occasionally problematic. We investigated whether strain rate (SR) imaging derived from tissue Doppler imaging (TDI) is able to discriminate HCM from H-LVH.

Methods and Results--Conventional echocardiography and TDI were performed with 34 patients with LVH and 16 reference subjects. Mean values of systolic strain (_sys), peak systolic SR, and early diastolic SR obtained from 8 left ventricular (LV) segments were calculated. LV pressures were recorded simultaneously in the patients. Patients were diagnosed with HCM (n=20) or H-LVH (n=14) on the basis of conventional echocardiography and endomyocardial biopsy findings. Multivariate analysis revealed that septum/posterior wall thickness ratio (P=0.00013) and _sys (P<0.0001) were each able to discriminate HCM from H-LVH. A _sys cutoff value of -10.6% discriminated between HCM and H-LVH with a sensitivity of 85.0%, specificity of 100.0%, and predictive accuracy of 91.2%. The combination of the septum/posterior wall thickness ratio and _sys discriminated HCM from H-LVH with a predictive accuracy of 96.1%. The _sys parameter was significantly correlated with pulmonary arterial wedge pressure, LV end-diastolic pressure, the peak positive first derivative of LV pressure, and the time constant of LV pressure decay.

Conclusions--SR imaging is able to discriminate HCM from H-LVH, with _sys reflecting myocardial contractile and lusitropic properties.

Key words: cardiomyopathy • echocardiography • diagnosis • hypertrophy • hypertension

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