Assessment of Left Ventricular Filling Patterns in Patients with Hypertrophic Cardiomyopathy
Although alterations in left ventricular (LV) early filling patterns have been observed in patients with hypertrophic cardiomyopathy (HCM), it is not well elucidated what factors are related to the altered filling patterns. We classified the filling patterns into 3 groups based on the normal values of early filling indices, peak filling rate (PFR, > 2.4 end-diastolic count [EDC]/s) and time to PFR (TPFR, < 180 ms), derived from high-temporal-resolution radionuclide ventriculography: group A with normal PFR and TPFR, group B with normal PFR but prolonged TPFR, and group C with reduced PFR and prolonged TPFR. Then, in 28 patients with nonobstructive HCM, 14 patients with localized septal or apical hypertrophy, 9 patients with extensive hypertrophy, and 5 patients with diffuse hypertrophy, we investigated the effects of the extent hypertrophy and the magnitude of diastolic asynchrony on the classified filling patterns. M-mode and two-dimensional echocardiograms demonstrated that patients with localized hypertrophy were frequently included in groups A and B, but patients with extensive hypertrophy were classed in group C. Quantitative analysis of regional filling function by sector analysis with radionuclide ventriculography revealed that the magnitude of diastolic asynchrony estimated by coefficient of variance of regional TPFR was the highest in group C among the 3 groups. Thus, the classified early filling patterns were closely related to the extent of hypertrophy and the magnitude of diastolic asynchrony. Since early filling is mainly determined by LV relaxation and abnormalities of relaxation may be related to the hypertrophic process, the classification of LV early filling patterns may be useful for assessing the degree of impaired LV relaxation in patients with HCM.
KeywordsHypertrophic Cardiomyopathy Peak Filling Rate Filling Pattern Radionuclide Ventriculography Early Filling
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