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Assessment of Left Ventricular Filling Patterns in Patients with Hypertrophic Cardiomyopathy

  • Yoshio Ishida
  • Akihiro Tani
  • Noboru Matsubara
  • Takakazu Morozumi
  • Masatsugu Hori
  • Akira Kitabatake
  • Kazufumi Kimura
  • Takenobu Kamada

Summary

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.

Keywords

Hypertrophic Cardiomyopathy Peak Filling Rate Filling Pattern Radionuclide Ventriculography Early Filling 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Hammermeister KE, Wabasse JR (1974) The rate of change of left ventricular volume in man. II. Diastolic events in health and disease. Circulation 49: 739–PubMedGoogle Scholar
  2. 2.
    Sanderson JE, Gibson DG, Brown DJ, Goodwin JF (1977) Left ventricular filling in hypertrophic cardiomyopathy: An angiographic study. Br Heart J 39: 661–670PubMedCrossRefGoogle Scholar
  3. 3.
    Bonow RO, Rosing DR, Bacharach SL, Green MV, Kent KM, Lipson LC, Maron BJ, Leon MB, Epstein SE (1981) Effects of verapamil on left ventricular systolic function and diastolic filling in patients with hypertrophic cardiomyopathy. Circulation 64(4): 787–796PubMedCrossRefGoogle Scholar
  4. 4.
    Hanrath P, Mathey DG, Siegert R, Bleifeld W (1980) Left ventricular relaxation and filling pattern in different forms of left ventricular hypertrophy: An echocardiographic study. Am J Cardiol 45: 15–23PubMedCrossRefGoogle Scholar
  5. 5.
    Inouye I, Massie B, Loge D, Topic N, Silverstein D, Simpson P, Tubau J (1984) Abnormal left ventricular filling: An early finding in mild to moderate systemic hypertension. Am J Cardiol 53: 120–126PubMedCrossRefGoogle Scholar
  6. 6.
    Takenaka K, Dabestani A, Gardin JM, Russel D, Clark S, Allfie A, Henry WL (1986) Left ventricular filling in hypertrophic cardiomyopathy: A pulsed Doppler echocardiographic study. J Am Coll Cardiol 7: 1263–1271PubMedCrossRefGoogle Scholar
  7. 7.
    Brutsaert DL, Rademakers FE, Sys SU (1984) Triple control of relaxation: Implications in cardiac disease. Circulation 69: 190–196PubMedCrossRefGoogle Scholar
  8. 8.
    Paulus WJ, Lorel BH, Craig WE, Wynne J, Murgo JP, Grossman W (1983) Comparison of the effects of nitroprusside and nifedipine on diastolic properties in patients with hypertrophic cardiomyopathy: Altered left ventricular loading or improved muscle inactivation? J Am Coll Cardiol 2: 879–886PubMedCrossRefGoogle Scholar
  9. 9.
    Gwathmey JK, Morgan JP (1985) Altered calcium handling in experimental pressure overload hypertrophy in the ferret. Circ Res 57: 836–843PubMedGoogle Scholar
  10. 10.
    Cannon RO, Rosing DR, Maron BJ, Leon MB, Bonow RO, Watson RM, Epstein SE (1985) Myocardial ischemia in hypertrophic cardiomyopathy: Contribution of inadequate vasodialtor reserve the elevated left ventricular filling pressures. Circulation 71- 234–243Google Scholar
  11. 11.
    Bertrand ME, Tilmant PY, Lablance JM, (1983) Apical hypertrophic cardiomyopathy: Clinical and metabolic studies. Eur Heart J 4 (suppl F): 127–133Google Scholar
  12. 12.
    Wnigle BJ, Epstein SE (1980) Hypertrophic cardiomyopathy: recent observations regarding the specificity of three hallmarks of the disease: asymmetric septal hypertrophy, septal disorganization and systolic anterior motion of the anterior mitral leaflet. Am J Cardiol 45: 141–154CrossRefGoogle Scholar
  13. 13.
    Maron BJ, Epstein SE (1980) Hypertrophic cardiomyopathy: recent observations regarding the specificity of three hallmarks of the disease: asymmetric septal hypertrophy, septal disorganization and systolic anterior motion of the anterior mitral leaflet. Am J Cardiol 45: 141–154PubMedCrossRefGoogle Scholar
  14. 14.
    Yamaguchi H, Ishimura T, Nishiyama S, Nagasaki F, Nakanishi S, Takatsu F, Nishijo T, Umeda T, Machii K (1977) Hypertrophic nonobstructive cardiomyopathy with giant negative T waves (apical hypertrophy): Ventriculographic and echocardiography features in 30 patients. Am J Cardiol 44(3): 401–412CrossRefGoogle Scholar
  15. 15.
    Bacharach SL, Green MV, Borer JS (1979) Instrumentation and data processing in cardiovascular nuclear medicine: evaluation of ventricular function. Semin Nucl Med 9: 257–274PubMedCrossRefGoogle Scholar
  16. 16.
    Vital DF, Green MV, Bacharach SL, Bonow RO, Watson RM, Findley SL, Jones AE (1983) Assessment of regional left ventricular function by sector analysis: A method for objective evaluation of radionuclide blood pool studies. Am J Cardiol 52: 1112–1119CrossRefGoogle Scholar
  17. 17.
    Sugrue DD, Dickie S, Myers MJ, Lavender JP, Mckenna WJ (1984) Effects of amiodarone on left ventricular ejection and filling in hypertrophic cardiomyopathy. 54: 1054–1058Google Scholar
  18. 18.
    Betocchi S, Bonow RO, Bacharach SL, Rosing DR, Maron BJ, Gree MV (1986) Isovolumic relaxation period in hypertrohic cardiomyopathy: Assessment by radionuclide angiography. J Am Coll Cardiol 7: 74–81PubMedCrossRefGoogle Scholar
  19. 19.
    Fioretti P, Brower RW, Meester GT, Serruys PW (1980) Interaction of left ventricular relaxation and filling during early diastole in human subjects. Am J Cardiol 46: 197–203PubMedCrossRefGoogle Scholar
  20. 20.
    Magorien DJ, Shaffer P, Bush C, Magorien RD, Kolibash AJ, Unverferth DV, Bashore TM (1984) Hemodynamic correlates for timing intervals, ejection rate and filling rate derived from the radionuclide angiographic volume curve. Am J Cardiol 53: 567–571PubMedCrossRefGoogle Scholar
  21. 21.
    Goethals MA, Housmans PR, Brutsaert DL (1982) Loading determinants of relaxation in cat papillary muscle. Am J Physiol 242: H303–H309PubMedGoogle Scholar
  22. 22.
    Zile MR, Gaasch WH, Wiegner AW, Robinson KG, Bing OHL (1987) Mechanical determinants of maximum isotonic lengthening rate in rat left ventricular myocardium. Circ Res 60: 815–823PubMedGoogle Scholar
  23. 23.
    Ishida Y, Meisner JS, Tsujioka K, Gallo JI, Yoran C, Frater RWM, Yellin EL (1986) Left ventricular filling dynamics: Influence of left ventricular relaxation and left atrial pressure. Circulation 74(1): 187–196PubMedCrossRefGoogle Scholar
  24. 24.
    Bonow RO, Frederick TM, Bacharach SL, Gree MV, Goose PW, Maron BJ, Rosing DR, (1983) Atrial systole and left ventricular filling in hypertrophic cardiomyopathy: Effect of verapamil. Am J Cardiol 51: 1386–1391PubMedCrossRefGoogle Scholar
  25. 25.
    Bonow RO, Vitale DF, Bacharach SL, Rosing DR, Frederick TM, Green MV (1984) Regional left ventricular asynchrony and impaired global left ventricular diastolic filling in hypertrophic cardiomyopathy. Effect of verapamil, (abstract) Circulation 70 (suppl 2): 303Google Scholar
  26. 26.
    Spirito P, Maron BJ, Chiarella F, Bellotti P, Tramarin R, Pozzoli M, Vecchio C (1985) Diastolic abnormalities in patients with hypertropic cardiomyopathy: relation to magnitude of left ventricular hypertrophy. Circulation 72(2): 310–316PubMedCrossRefGoogle Scholar
  27. 27.
    Ishida Y, Kim BH, Matsubara N, Takeda H, Tsuneoka Y, Hiraoka T, Kimura K, Kamada T (1986) LV early filling function is diffusely impaired in hypertrophic cardiomyopathy with localized hypertrophy, (abstract) Circulation 74(4) (suppl 2): 451Google Scholar

Copyright information

© Springer-Verlag Tokyo 1989

Authors and Affiliations

  • Yoshio Ishida
  • Akihiro Tani
  • Noboru Matsubara
  • Takakazu Morozumi
  • Masatsugu Hori
  • Akira Kitabatake
  • Kazufumi Kimura
  • Takenobu Kamada
    • 1
  1. 1.The First Department of Medicine and Division of Nuclear MedicineOsaka University School of MedicineOsakaJapan

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