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Dynamic change of mitral apparatus as potential cause of left ventricular outflow tract obstruction in hypertrophic cardiomyopathy.

Authors
 Hye Jin Hwang  ;  Eui-Young Choi  ;  Jun Kwan  ;  Sung Ai Kim  ;  Chi Young Shim  ;  Jong-Won Ha  ;  Se-Joong Rim  ;  Namsik Chung  ;  Sung Soon Kim 
Citation
 EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY , Vol.12(1) : 19-25, 2011 
Journal Title
EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY
ISSN
 1525-2167 
Issue Date
2011
MeSH
Cardiomyopathy, Hypertrophic/diagnostic imaging* ; Cardiomyopathy, Hypertrophic/physiopathology* ; Diastole/physiology ; Echocardiography, Three-Dimensional* ; Female ; Humans ; Image Interpretation, Computer-Assisted ; Linear Models ; Male ; Middle Aged ; Mitral Valve/diagnostic imaging* ; Mitral Valve/physiopathology* ; Software ; Statistics, Nonparametric ; Systole/physiology ; Ventricular Outflow Obstruction/diagnostic imaging* ; Ventricular Outflow Obstruction/physiopathology*
Keywords
Hypertrophic cardiomyopathy ; Left ventricular outflow tract obstruction ; Echocardiography.
Abstract
AIMS: the geometry of the mitral apparatus changes dynamically throughout systole and diastole. We investigated how geometric dynamics of the mitral apparatus could affect the haemodynamics of the outflow tract in patients with hypertrophic cardiomyopathy presenting with systolic anterior motion (HCM(SAM)) using three-dimensional (3D) echocardiography.

METHODS AND RESULTS: we obtained transthoracic volumetric images in 21 patients with HCM(SAM) with differing trans-left ventricular (LV) outflow tract pressure gradient (PG(LVOT)) and in 23 controls. Original software was used to crop the 3D data into 18 radial planes; the mitral annulus, leaflets, coaptation point, protruding septum, and papillary muscles (PMs) tips were traced in each plane. The data were then reconstructed for 3D distance measurements and volumetric assessment. Shorter coaptation-septal distance (12 ± 4 vs. 21 ± 3 mm, P < 0.001), shorter inter-PM distance (13 ± 5 vs. 18 ± 4 mm, P = 0.02), and larger mitral tenting volume/body surface area (TVindex) (2.1 ± 1 vs. 0.5 ± 0.3 mL/m(2), P < 0.001) were associated with HCM(SAM) vs. control. PG(LVOT) increased with TVindex (r = 0.51, P = 0.01), and decreased with coaptation-septal distance(r = -0.83, P < 0.001) and the inter-PM distance (r = -0.69, P < 0.001) at mid-systole but not at mid-diastole (all P> 0.05). In addition, the coaptation-septal distance, TVindex, and inter-PM distance correlated each other (all P < 0.05). After adjustment for measures of mitral geometric change, the coaptation-septal distance was closely associated with PG(LVOT) (β = -0.73, P < 0.001).

CONCLUSION: these findings suggest that dynamic geometric changes by interaction of PMs, mitral tenting, and the coaptation point at mid-systole may be important contributors to outflow obstruction in HCM(SAM).
Files in This Item:
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DOI
10.1093/ejechocard/jeq092
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Sung Soon(김성순)
Kim, Sung Ai(김성애)
Shim, Chi Young(심지영) ORCID logo https://orcid.org/0000-0002-6136-0136
Rim, Se Joong(임세중) ORCID logo https://orcid.org/0000-0002-7631-5581
Chung, Nam Sik(정남식)
Choi, Eui Young(최의영) ORCID logo https://orcid.org/0000-0003-3732-0190
Ha, Jong Won(하종원) ORCID logo https://orcid.org/0000-0002-8260-2958
Hwang, Hye Jin(황혜진)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/93117
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