P825Usefulness of tissue Doppler imaging in disclosure of right ventricle dysfunction in patients with hypertrophic cardiomyopathy.


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Abstract

Purpose: Abnormality in structural myocardial proteins in congenital hypertrophic cardiomyopathy caused by gen's mutations results in systolic and diastolic dysfunction of hypertrophic left ventricle (LV) despite of preserved ejection fraction. However the role of right ventricle (RV) in pathophysiology of the disease remains unclear.Material and methods: The study was conducted in 146 patients with HCM, aged 46,3±15,06 years (60,3% of males) and 50 healthy individuals, aged 41,54±15,54 years (54% of males), who formed a control group. There were no differences in the LV ejection fraction (71,88 ±8,14% in HCM vs 71,66±2,69% in control's). Transthoracic echocardiography was performed using VIVID 7 ultrasound scanner (GE Vingmed). TDI was used to assess longitudinal myocardial global [E/E', global function index (GFI) as E/E'/S'] and regional function at septal, lateral, anterior and posterior walls of LV and free wall of RV in each segment (the base, mid and apical) using 4 and 2-chamber views. Postprocessing analysis of 3 consecutive cardiac cycles with measurements of strain (SI), strain rate both systolic (SRs) and diastolic (SRE'; SRA'), isovolumic peak positive velocities (IVCv) were performed. Myocardial acceleration during isovolumic contraction (IVA) was calculated using following formula: IVA [cm/s2] = IVCv / IVCt. TDI parameters were compared with left ventricle mass index (LVMI) and left atrial area (LAA).Results: Compared to controls, HCM patients featured significant impairment of systolic and diastolic function of both ventricles (significant decrease in E/E', GFI, SI, SRs, SRE'). TDI analysis of right ventricle confirmed major impairment of IVA with mean value of 112,44±64,12 cm/s2 in HCM group vs 163,66±66,25 cm/s2 in control's (p<0,00001). Significant correlations between IVA of RV and morphological and functional parameters of LV like LVMI (r=-0,28; p<0,002), LAA (r=-0,28; p<0,05), GFI ivs (r=-0,33; p<0,001), SI (r=-0,29; p<0,003), SRs (r=-0,28; p<0,002) and IVA (r=0,25; p<0,05) were established. IVA didn't correlate with diastolic indices: E/E', SRE' and SRA'.Conclusions: Hypertrophic cardiomyopathy patients exhibit impairment of systolic and diastolic function of both ventricles. Changes in right ventricle function may represent primary damage of myocardium.

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