Usefulness of Tissue Doppler Imaging to Identify Low Risk Patients with Diagnosis of Hypertrophic Cardiomyopathy

pp. 97-104

Abstract

Background: Pulsed tissue Doppler imaging is a useful tool for the early detection of hypertrophic cardiomyopathy and the differential diagnosis of this disease from other secondary causes of hypertrophy.
Objective: The aim of the study was to determine the prognostic significance of preserved systolic tissue velocities in patients with diagnosis of hypertrophic cardiomyopathy.
Methods: One hundred and forty six patients with diagnosis of hypertrophic cardiomyopathy were prospectively included by means of a Doppler echocardiography study. Systolic tissue velocities were obtained from the averaged septal and lateral velocities. Patients with preserved systolic tissue velocities (Sa ≥ 8 cm/s; upper quartile) were compared with those presenting decreased velocities. The primary endpoint was defined as the presence of sudden death, stroke, heart failure, or hospitalization for cardiovascular causes at follow up.
Results: Twenty nine percent of patients (n = 43) presented preserved systolic tissue velocities in the tissue Doppler images, mostly in men (76.7% vs. 53.4%, p = 0.009) and with no age differences. Ventricular diameter and thickness were similar between the two groups while the atrial area was significantly lower (23.7 ± 6.7 vs. 28.8 ± 8, p <0.01). At follow up (median of 2.7 years), the number of events increased significantly as systolic pulsed tissue Doppler velocities decreased. No patient from the group with preserved systolic tissue velocities presented the combined endpoint, with significant differences with respect to the control group (0% vs. 21.6%, p = 0.001), and a negative predictive value of 100%.
Conclusions: In our population with hypertrophic cardiomyopathy, the presence of preserved systolic tissue velocities in pulsed tissue Doppler imaging identified low-risk patients with a very low number of events at follow up and high negative predictive value.