scholarly journals Evolution of ventricular hypertrophy and myocardial mechanics in physiological and pathological hypertrophy

2019 ◽  
Vol 126 (2) ◽  
pp. 354-362 ◽  
Author(s):  
Fatih Yalçin ◽  
Nagehan Kucukler ◽  
Oscar Cingolani ◽  
Blaid Mbiyangandu ◽  
Lars Sorensen ◽  
...  
Keyword(s):  
Ventricular Hypertrophy ◽  
Physiological Stress ◽  
Progressive Increase ◽  
Global Function ◽  
Tissue Velocity ◽  
Functional Differences ◽  
Velocity Imaging ◽  
Asymmetric Septal Hypertrophy ◽  
Septal Hypertrophy ◽  
Physiological Hypertrophy

Left ventricular hypertrophy (LVH) is an adaptive response to physiological or pathological stimuli, and distinguishing between the two has obvious clinical implications. However, asymmetric septal hypertrophy and preserved cardiac function are noted in early stages in both cases. We characterized the early anatomic and functional changes in a mouse model of physiological and pathological stress using serial echocardiography-based morphometry and tissue velocity imaging. Weight-matched CF-1 male mice were separated into Controls ( n = 10), treadmill Exercise 1 h daily for 5 days/wk ( n = 7), and transverse aortic constriction (TAC, n = 7). Hypertrophy was noted first in the left ventricle basal septum compared with other segments in Exercise (0.84 ± 0.02 vs. 0.79 ± 0.03 mm, P = 0.03) and TAC (0.86 ± 0.05 vs. 0.77 ± 0.04 mm, P = 0.02) at 4 and 3 wk, respectively. At 8 wk, eccentric LVH was noted in Exercise and concentric LVH in TAC. Septal E/E′ ratio increased in TAC (32.6 ± 3.7 vs. 37 ± 6.2, P = 0.002) compared with the Controls and Exercise (32.3 ± 5.2 vs. 32.8 ± 3.8 and 31.2 ± 4.9 vs. 28.2 ± 5.0, respectively, nonsignificant for both). Septal s′ decreased in TAC (21 ± 3.6 vs. 17 ± 4.2 mm/s, P = 0.04) but increased in Exercise (19.6 ± 4.1 vs. 29.2 ± 2.3 mm/s, P = 0.001) and was unchanged in Controls (20.1 ± 4.2 vs. 20.9 ± 5.1 mm/s, nonsignificant). With similar asymmetric septal hypertrophy and normal global function during the first 4–8 wk of pathological and physiological stress, there is an early marginal increase with subsequent decrease in systolic tissue velocity in pathological but early and progressive increase in physiological hypertrophy. Tissue velocities may help adjudicate between these two states when there are no overt anatomic or functional differences. NEW & NOTEWORTHY Pathological and physiological stress-induced ventricular hypertrophy have different clinical connotations but present with asymmetric septal hypertrophy and normal global function in their early stages. We observed a marginal but statistically significant decrease in systolic tissue velocity in pathological but progressive increase in velocity in physiological hypertrophy. Tissue velocity imaging could be an important tool in the management of asymmetric septal hypertrophy by adjudicating between these two etiologies when there are no overt anatomic or functional differences.

scholarly journals P873 A rare and potentially treatable cause of left ventricular hypertrophy

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
C Y Wong
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Left Ventricular Hypertrophy ◽  
Ejection Fraction ◽  
Fabry Disease ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Valvular Regurgitation ◽  
Outflow Obstruction ◽  
Asymmetric Septal Hypertrophy ◽  
Septal Hypertrophy

Abstract Introduction A 67-year-old man was referred for care of "asymptomatic hypertrophic cardiomyopathy". He did not have hypertension. No significant positive family history could be elicited. Electrocardiogram showed sinus rhythm with voltage criteria of left ventricular hypertrophy (LVH). Outside Transthoracic Echocardiogram (TTE) reported normal ejection fraction with asymmetric septal hypertrophy without outflow obstruction. He was put on observation for few years and was not any treatment. On first encounter in our clinic, physical examination including skin and eye assessment, and laboratory tests including renal function were unremarkable. Procedure TTE was repeated in our clinic showing normal left ventricular size with ejection fraction 55%, and impaired diastolic relaxation. There was asymmetric septal hypertrophy with septal thickness 2.1 cm (Figure A). There was mild systolic anterior motion of mitral apparatus and mild mitral regurgitation, without resting or Valsalva provoked outflow obstruction. Global longitudinal strain was -7.7% with most prominent abnormalities seen at apex, mid to basal anteroseptal and anterior wall (Figure B). Further assessment by Cardiac MRI showed similar asymmetric septal wall thickening. Late gandolinium enhancement study demonstrated patchy fluffy hyperenhancement of the mid wall of the basal to mid anteroseptal segment, and mid to apical anterior segment, suggestive of myocardial fibrosis (Figure C1 and C2). Dried spot blood was sent to Taiwan for enzyme study which revealed partial acid alpha-galactosidase A deficiency. Further genetic study detected a mutation of Hemizygous NM_000169.2(GLA):c.640-801[G > A] at intron 4. Finally endomyocardial biopsy was done which confirmed the cardiac involvement of Fabry disease (Figure D, myelin body shown under electron microscopy). This gentleman was referred for consideration of Enzyme Replacement Therapy (ERT). Discussion Fabry disease is an X-linked glycolipid storage disease with accumulation of globotriaosylceramide in lysosomes in multiple cell types throughout the body leading to various organ involvement. Cardiac manifestations include unexplained LVH, valvular regurgitation, conduction abnormalities etc. It occurs in up to 0.3-5% of patients with hypertrophic cardiomyopathy. Fabry disease should be considered as a differential diagnosis in all men with sporadic or non-autosomal dominant transmission of unexplained LVH, since treatment with ERT is available which may reduce LVH and improve myocardial function, although any impact on long term outcome has not yet been established. Conclusion This case illustrated a rare but potentially treatable cause of hypertrophic cardiomyopathy. Myocardial strain imaging should be integrated in routine TTE study for assessment of unexplained left ventricular hypertrophy. Multi-modality imaging and multi-specialty approach help in identifying patients of cardiac variant of Fabry disease who may benefit from ERT. Abstract P873 Figure.

scholarly journals Cardiac amyloidosis: The great masquerader

2018 ◽  
Vol 2018 (2) ◽  
Author(s):  
Jubran Rind ◽  
Nagib Chalfoun ◽  
Richard McNamara
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Cardiac Mri ◽  
Cardiac Amyloidosis ◽  
Ventricular Hypertrophy ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Asymmetric Septal Hypertrophy ◽  
Left Ventricular Outflow ◽  
Septal Hypertrophy

Cardiac amyloidosis is an elusive condition that is notorious for mimicking various cardiovascular conditions that present with left ventricular hypertrophy (LVH). The hypertrophy in amyloidosis is typically diffuse; however, rare reports of echocardiographic resemblances with hypertrophic cardiomyopathy (HCM) exist, such as asymmetric septal hypertrophy and left ventricular outflow tract obstruction. Cardiac MRI can help differentiate amyloidosis from hypertrophic cardiomyopathy in unclear situations. This differentiation from HCM and other forms of cardiomyopathy has important treatment implications. Here we present the case of a 76-year-old man with cardiomyopathy who had echocardiographic features of asymmetric hypertrophic cardiomyopathy but was correctly diagnosed with amyloidosis with the help of cardiac MRI and ECG.

Messung der myokardialen Geschwindigkeit mittels Gewebe-Doppler beim gesunden Hund

2011 ◽  
Vol 39 (02) ◽  
pp. 69-78 ◽  
Author(s):  
M. Killich ◽  
K. Hartmann ◽  
G. Wess
Keyword(s):  
Klinische Relevanz ◽  
Tissue Velocity ◽  
Velocity Imaging

Zusammenfassung Ziele der Studie waren die Evaluierung der myokardialen Gewebegeschwindigkeit mittels Gewebe-Doppler (Tissue Velocity Imaging, TVI) hinsichtlich der Reproduzierbarkeit sowie die Erstellung von Referenzwerten für die systolische und diastolische longitudinale Myokardbewegung. Weiterhin wurde der Einfluss von Geschlecht, Herzfrequenz, Alter, Gewicht und Rasse untersucht. Material und Methoden: Das Probandenkollektiv umfasste 199 gesunde Hunde. Systolische und diastolische longitudinale TVI wurden mittels Farb-Gewebe-Doppler im linksapikalen Vierkammerblick für rechte freie Wand, Septum und linke freie Wand einzeln aufgezeichnet und ausgewertet. Ergebnisse: Die Variationskoeffizienten für die Intrareader-Variabilität lagen alle unter 10%. Die Variationskoeffizienten für die Interreader-Variabilität unterschritten 12,4%. Das TVI wies eine heterogene Verteilung im Myokard mit einem apikobasalen Geschwindigkeitsgradienten für systolische und diastolische Parameter auf. Es zeigte keine Abhängigkeit vom Geschlecht. Dagegen beeinflussten Herzfrequenz, Alter, Gewicht und Rasse das TVI signifikant. Schlussfolgerung und klinische Relevanz: Das TVI stellt eine Technik mit guter Reproduzierbarkeit dar. Nachteil des Verfahrens ist die Abhängigkeit von Herzfrequenz, Alter, Gewicht und Rasse der Hunde. Die Studie belegt, dass das TVI beim Hund als neue Methode in der Echokardiographie eingesetzt werden kann. Diese Arbeit stellt eine Grundlage für weitere Studien auf dem Gebiet der Gewebe-Dopplertechnik dar und liefert für den klinischen Einsatz Referenzwerte für Hunde verschiedener Gewichtsgruppen.

Modified Septal Myectomy Using a Curved Knife for Left Ventricular Septal Hypertrophy

2014 ◽  
Vol 17 (5) ◽  
pp. 269
Author(s):  
Shinya Takahashi ◽  
Taiichi Takasaki ◽  
Futoshi Tadehara ◽  
Takahiro Taguchi ◽  
Keijiro Katayama ◽  
...  
Keyword(s):  
Blood Flow ◽  
Chest Pain ◽  
Aortic Valve ◽  
Cross Section ◽  
Left Ventricular ◽  
Chest Discomfort ◽  
Septal Myectomy ◽  
Asymmetric Septal Hypertrophy ◽  
Septal Hypertrophy ◽  
Septal Myocardium

An 86-year-old woman presented with chest pain and discomfort. Echocardiography revealed severe aortic valve stenosis and asymmetric septal hypertrophy. Aortic valve replacement and myectomy were performed using a curved knife. The blade was U-shaped in cross-section, and was curved upward along the long axis. Hypertrophic septal myocardium was removed along the long axis of the left ventricle (LV), and a groove for blood flow was constructed. The patient was discharged uneventfully without recurrence of her chest discomfort. Our result suggested that a curved knife is a reasonable option for transaortic septal myectomy in patients with obstructive LV hypertrophy.

scholarly journals Reference values for fetal tissue velocity imaging and a new approach to evaluate fetal myocardial function

2013 ◽  
Vol 11 (1) ◽  
Author(s):  
Nina NE Elmstedt ◽  
Jonas JJ Johnson ◽  
Britta BL Lind ◽  
Kjerstin KFW Ferm-Widlund ◽  
Lotta LH Herling ◽  
...  
Keyword(s):  
Reference Values ◽  
Myocardial Function ◽  
Fetal Tissue ◽  
New Approach ◽  
Tissue Velocity ◽  
Velocity Imaging

Washout rates of Tc-99m tetrofosmin in asymmetric septal hypertrophy

2005 ◽  
Vol 19 (1) ◽  
pp. 29-33 ◽  
Author(s):  
Gülgün Büyükdereli ◽  
Mehmet Kanadasi ◽  
Mustafa Kibar
Keyword(s):  
Asymmetric Septal Hypertrophy ◽  
Septal Hypertrophy

Abstract 2205: Intraventricular Septal Intramural Asynchrony in Patients with Dilated Cardiomyopathy Using Tissue Velocity Imaging Correlates with the Severity of Myocardial Fibrosis

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Jun Tanaka ◽  
Satoshi Nakatani ◽  
Makoto Amaki ◽  
Hideaki Kanzaki ◽  
Shuji Hashimoto ◽  
...  
Keyword(s):  
Dilated Cardiomyopathy ◽  
Myocardial Fibrosis ◽  
Tissue Sample ◽  
Normal Subjects ◽  
Myocardial Contraction ◽  
Cellular Hypertrophy ◽  
Time To Peak ◽  
Tissue Velocity ◽  
Velocity Imaging ◽  
Velocity Images

Dilated cardiomyopathy (DCM) is histologically characterized by myocardial fibrosis and cellular hypertrophy. These myocardial changes may affect timing of regional peak contraction. We investigated whether there was a correlation between intraventricular septal (IVS) intramural asynchrony based on tissue velocity imaging and the histologic changes. We obtained apical 4-chamber tissue velocity images in 27 normal subjects and 22 patients with DCM undergoing myocardial biopsy using Vivid 7 (GE). We set 6 tandem regions of interest (ROIs) on the mid level of the IVS and measured the time to peak myocardial contraction (Ts) from the QRS onset at each ROI. We defined the standard deviation of Ts (Ts-SD) as an index of IVS asynchrony. Further, we analyzed a correlation between Ts-SD and the degree of myocardial fibrosis and cellular hypertrophy. The degree of myocardial fibrosis and cellular hypertrophy was graded qualitatively (0 to 3 scale) according to the percent of fibrosis occupied of the tissue sample and cell size. Ts-SD was larger in patients with DCM compared with normal subjects (13.9±12.3 vs. 6.2±4.0 ms, p<0.05), suggesting asynchronous contraction of IVS in DCM. Ts-SD showed a significant correlation with the degree of myocardial fibrosis (grade 1, 6.9±3.5 ms; grade 2, 15.7±3.5 ms; grade 3, 25.9±5.3 ms; p<0.05), while not with that of cellular hypertrophy (p=0.50). There was intramural asynchrony in IVS in DCM. This method could predict the degree of myocardial fibrosis noninvasively. Because myocardial fibrosis is the substrate for heart failure in DCM, the present method should provide clinically important information.

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