Transthoracic Doppler echocardiographic analysis of phasic coronary blood flow velocity in hypertrophic cardiomyopathy.

Abstract

Objective-To use transthoracic Doppler echocardiography to assess coronary blood flow non-invasively in patients with hypertrophic cardiomyopathy. Design-High frequency transthoracic Doppler echocardiography was used to assess resting phasic coronary velocity patterns in patients with hypertrophic cardiomyopathy and to define the relation between coronary flow patterns and clinical, echocardiographic, and haemodynamic manifestations of this condition. Patients with hypertrophic cardiomyopathy commonly have evidence of myocardial ischaemia despite angiographically normal coronary arteries. Alterations of the coronary circulation have been described in left ventricular hypertrophy and proposed as a mechanism for the development of angina pectoris in these patients. Invasive studies have described a reduced cardiac reserve in patients with left ventricular hypertrophy secondary to many conditions, including aortic stenosis, systemic hypertension, and hypertrophic cardiomyopathy.' 5 There are few data available on coronary blood flow in unsedated patients with hypertrophic cardiomyopathy. Transthoracic echocardiography allows non-invasive evaluation of coronary flow patterns in the distal segment of the left anterior descending coronary artery (LAD).6 In the present study transthoracic echocardiography was used to assess phasic coronary velocity patterns in patients with hypertrophic cardiomyopathy and to define the relation between coronary flow patterns and clinical and haemodynamic manifestations of this condition. Methods PATIENTSFifteen patients (10 men and five women, mean (SD) age 49 (10 3) years) admitted to hospital for assessment of hypertrophic cardiomyopathy were studied. The patients were selected from a group of 21 because of the ease of imaging the LAD. Hypertrophic cardiomyopathy was diagnosed on the basis of an echocardiographic demonstration of a hypertrophied and non-dilated left ventricle in the absence of a secondary cause of left ventricular hypertrophy. Thirteen patients had a thickness ratio > 1 5 between the interventricular septum and the posterior wall. Of the remaining two patients, one had evidence of an intraventricular gradient by echocardiography and cardiac catheterisation, and the other had severe hypertrophy without coronary artery disease or hypertension. Eight patients had symptoms of chest pain, palpitation, or dyspnoea. Coronary angiography was performed in 11 patients, all of whom had normal coronary arteries. A control group of 16 normal participants (nine men and seven women, mean age 61 2 (10-7) years) was also studied. ECHOCARDIOGRAPHY OF THE LAD

Transthoracic echocardiographic evaluation of coronary flow reserve in patients with hypertrophic cardiomyopathy

“…With regard to CFtvi, Crowley et al [24] showed no difference in CFtvi between HCMP patients and normal subjects. However, in our study, baseline CFtvi was also significantly higher in HCMP patients than in normal subjects.…”

Value of Transthoracic Echocardiography for the Detection of High-Grade Coronary Artery Stenosis: Prospective Evaluation in 50 Consecutive Patients Scheduled for Coronary Angiography

“…The distal LAD flow velocities we measured noninvasively with transthoracic echocardiography parallel closely the results of other investigators. 6,12,13 Other investigators have found that in proximal parts of the coronary arteries measured semi-invasively with transesophageal echocardiography, flow velocities vary from 0.34 ± 0.08 m/s to 0.81 ± 0.1 m/s. 14,15 In by far the largest group of patients scheduled for coronary angiography, Kasprzak et al 16 reported values for the LM (0.72 ± 0.21 m/s), proximal LAD (0.69 ± 0.27 m/s), and proximal Cx (0.77 ± 0.27 m/s) that agree well with our results.…”

Diastolic flow velocity pattern of the left anterior descending coronary artery in hypertrophied heart, with special reference to the difference between hypertrophic cardiomyopathy and hypertensive left ventricular hypertrophy

“…It has been reported that the LAD flow velocity pattern during diastole in patients with HCM is characterized by slow acceleration during early diastole [6][7][8][9] and rapid deceleration after the peak velocity [7]. The former characteristic finding may be due to the slow acceleration of the diastolic pressure gradient curve between the aorta and the LV caused by the slower downslope of the LV pressure curve reflecting the disturbance of early diastolic relaxation.…”

“…The flow velocity pattern of the LAD in patients with hypertrophic cardiomyopathy (HCM) is characterized by decreased or retrograde systolic flow and the slow acceleration of diastolic flow [6][7][8][9]. In patients with hypertensive left ventricular hypertrophy (LVH), however, the characteristics of the LAD flow velocity pattern and the difference from that in HCM have not been fully investigated [10].…”