Tissue Doppler imaging and prognosis in asymptomatic or mildly symptomatic patients with hypertrophic cardiomyopathy

Assessment of left ventricular (LV) systolic and diastolic functions by tissue Doppler imaging (TDI) has been reported to be useful for predicting the prognosis in patients with hypertrophic cardiomyopathy (HCM). The purpose of this study was to evaluate the clinical significance of TDI parameters for the prediction of cardiovascular events in asymptomatic or mildly symptomatic patients with HCM.

Eighty-five HCM patients (52 males, 55.6 ± 14.8 years.) belonging to the New York Heart Association (NYHA) functional class I or II were enrolled in this study. Patients with the LV systolic dysfunction or a clinically documented history of atrial fibrillation were excluded. The combined endpoints were HCM-related death; admission for heart failure or stroke; new episode of atrial fibrillation; and worsening of heart failure symptoms (NYHA class III). During a follow-up period of 4.5 ± 1.7 years, 11 patients achieved the combined endpoints. Patients who experienced cardiovascular events had a larger LV size and left atrial volume compared with those who did not. Peak systolic, early diastolic (e′), and late diastolic TDI velocities at the septal corner were lower in patients who experienced cardiovascular events; moreover, the septal E/e′ value was higher in these patients. Multivariate forward regression analysis revealed the deceleration times of E and the septal E/e′ to be independent predictors of cardiovascular events.

Assessment of the diastolic function by TDI is useful for risk stratification in HCM patients with no or mild symptoms. TDI measurements should be incorporated into the clinical management of HCM.