Amplitudes, Durations, and Timings of Apically Directed Left Ventricular Myocardial Velocities: II. Systolic and Diastolic Asynchrony in Patients with Left Ventricular Hypertrophy,☆☆,

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Abstract

Background: Regional myocardial dysfunction may be the earliest manifestation of myocardial disease and can occur in the absence of abnormalities of global left ventricular (LV) function. The LV long-axis function, which is mainly due to subendocardial muscle fibers, may become abnormal in the presence of normal short-axis function. This study investigates the temporal and spatial characteristics of the LV long-axis function in patients with secondary LV hypertrophy in the presence of normal systolic function. Methods and Results: LV long-axis myocardial velocities were recorded in 18 patients with LV hypertrophy and preserved regional and global systolic function with Doppler tissue imaging. Apically directed myocardial velocities were recorded from the basal, mid, and apical segments of the four LV walls, and their amplitudes, timings, and durations were measured. The abnormalities uncovered by the analysis of regional myocardial velocities included (1) asynchrony in the onset of myocardial contraction circumferentially, (2) presence of postejection LV shortening, (3) asynchrony in the onset of early myocardial lengthening circumferentially, (4) reduced early myocardial lengthening velocity, (5) reduced early to late myocardial lengthening velocity and extents circumferentially, and (6) lack of variation in the basal myocardial velocities circumferentially in contrast to normal individuals. Conclusions:Patients with secondary LV hypertrophy with preserved regional and global systolic performance have distinct abnormalities in the timings and amplitudes of apically directed myocardial velocities. These abnormalities may explain some of the changes in LV global diastolic behavior and may also serve as markers of early regional myocardial dysfunction. (J Am Soc Echocardiogr 1998;11:112-8.)

Section snippets

Study Subjects

Eighteen consecutive patients with LV hypertrophy defined as LV free wall thickness of 12 mm or more were prospectively recruited for the study if they also met the following criteria: (1) presence of normal sinus rhythm, (2) absence of intraventricular conduction abnormalities, (3) absence of segmental wall motion abnormalities, history of angina, or a myocardial infarction, (4) LV ejection fraction of G55%, and (5) absence of significant mitral or aortic valve disease. All patients had a

Baseline Patient Characteristics

The baseline echocardiographic characteristics are summarized in Table 1 and are contrasted with those of the normal control group.

. Baseline mitral and aortic flow analysis

Empty CellNormalLV hypertrophyp Value
RR interval (msec)871 ± 169951 ± 178NS
LV isovolumic relaxation time (msec)92 ± 19121 ± 41<0.01
E wave amplitude (cm/sec)80 ± 2675 ± 24NS
E wave deceleration time (msec)194 ± 50234 ± 67<0.05
E wave duration (msec)238 ± 53252 ± 53NS
Q wave to onset of E wave (msec)450 ± 45494 ± 48<0.01
A wave amplitude

DISCUSSION

Results of this study indicate that patients with secondary LV hypertrophy and preserved global systolic performance have altered systolic and diastolic LV myocardial mechanics along the major axis. These abnormalities uncovered by the analysis of regional myocardial velocities include (1) asynchrony in the onset of myocardial contraction circumferentially, (2) presence of postejection LV shortening, (3) asynchrony in the onset of early myocardial lengthening circumferentially, (4) reduced

References (11)

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From the Sections of Cardiology, Jerry L. Pettis VA Medical Center and Loma Linda University School of Medicine.

☆☆

Reprint requests: Ramdas G. Pai, MD, FRCP(E), Cardiology (111C), Jerry L. Pettis VA Hospital, 11201 Benton St., Loma Linda, CA 92357.

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