Left ventricular filling in hypertrophic cardiomyopathy: A pulsed Doppler echocardiographic study

Abnormal left ventricular diastolic properties have been described in patients with hypertrophic cardiomyopathy. To evaluate the diastolic filling characteristics of the left ventricle in patients with this disease, pulsed Doppler echocardiography was used to study mitral flow velocity in 17 patients with hypertrophic cardiomyopathy (11 with and 6 without systolic anterior motion of the mitral valve) and 16 age-matched normal subjects. There were no statistically significant differences between patients with hypertrophic cardiomyopathy with and without systolic anterior motion with regard to ventricular septal thickness, left ventricular posterior wall thickness, left ventricular internal dimensions or the extent of hypertrophy evaluated by two-dimensional echocardiography. Mitral regurgitation was detected by Doppler echocardiography in all 11 patients with and in 2 (33 %) of the 6 patients without systolic anterior motion of the mitral valve. Early and late diastolic peak flow velocity, the ratio of late to early diastolic peak flow velocity and deceleration of early diastolic flow were measured from Doppler mitral flow velocity recordings. There were no statistically significant differences in these four indexes between the patients with systolic anterior motion and normal subjects. In contrast, the patients with hypertrophic cardiomyopathy without systolic anterior motion showed lower early diastolic peak flow velocity, higher ratio of late to early diastolic peak flow velocity and lower deceleration of early diastolic How compared with the patients with systolic anterior motion and normal subjects, suggesting impaired left ventricular diastolic filling. These observed differences in mitral flow velocity between patients with hypertrophic cardiomyopathy with and without systolic anterior motion of the mitral valve may be explained by the more frequent occurrence of mitral regurgitation, which augments early diastolic left ventricular filling, or the less extensive myopathic process reported previously in patients with systolic anterior motion, rather than by differences in the extent of hypertrophy.