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How does morphology impact on diastolic function in hypertrophic cardiomyopathy? A single centre experience

OBJECTIVES: It is unclear if morphology impacts on diastole in hypertrophic cardiomyopathy (HCM). We sought to determine the relationship between various parameters of diastolic function and morphology in a large HCM cohort. SETTING: Tertiary referral centre from Stanford, California, USA. PARTECIPA...

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Autores principales: Finocchiaro, Gherardo, Haddad, Francois, Pavlovic, Aleksandra, Magavern, Emma, Sinagra, Gianfranco, Knowles, Joshua W, Myers, Jonathan, Ashley, Euan A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4067898/
https://www.ncbi.nlm.nih.gov/pubmed/24928584
http://dx.doi.org/10.1136/bmjopen-2014-004814
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author Finocchiaro, Gherardo
Haddad, Francois
Pavlovic, Aleksandra
Magavern, Emma
Sinagra, Gianfranco
Knowles, Joshua W
Myers, Jonathan
Ashley, Euan A
author_facet Finocchiaro, Gherardo
Haddad, Francois
Pavlovic, Aleksandra
Magavern, Emma
Sinagra, Gianfranco
Knowles, Joshua W
Myers, Jonathan
Ashley, Euan A
author_sort Finocchiaro, Gherardo
collection PubMed
description OBJECTIVES: It is unclear if morphology impacts on diastole in hypertrophic cardiomyopathy (HCM). We sought to determine the relationship between various parameters of diastolic function and morphology in a large HCM cohort. SETTING: Tertiary referral centre from Stanford, California, USA. PARTECIPANTS: 383 patients with HCM and normal systolic function between 1999 and 2011. A group of 100 prospectively recruited age-matched and sex-matched healthy participants were used as controls. PRIMARY AND SECONDARY OUTCOME MEASURES: Echocardiograms were assessed by two blinded board-certified cardiologists. HCM morphology was classified as described in the literature (reverse, sigmoid, symmetric, apical and undefined). RESULTS: Reverse curvature morphology was most commonly observed (218 (57%). Lateral mitral annular E′<12 cm/s was present in 86% of reverse, 88% of sigmoid, 79% of symmetric, 86% of apical and 81% of undefined morphology, p=0.65. E/E′ was similarly elevated (E/E′: 12.3±7.9 in reverse curvature, 12.1±6.1 in sigmoid, 12.7±9.5 in symmetric, 9.4±4.0 in apical, 12.7±7.9 in undefined morphology, p=0.71) and indexed left atrial volume (LAVi)>40 mL/m(2) was present in 47% in reverse curvature, 33% in sigmoid, 32% in symmetric, 37% in apical and 32% in undefined, p=0.09. Each morphology showed altered parameters of diastolic function when compared with the control population. Left ventricular (LV) obstruction was independently associated with all three diastolic parameters considered, in particular with LAVi>40 mL/m(2) (OR 2.04 (95% CI 1.23 to 3.39), p=0.005), E/E′>15 (OR 4.66 (95% CI 2.51 to 8.64), p<0.001) and E′<8 (OR 2.55 (95% CI 1.42 to 4.53), p=0.001). Other correlates of diastolic dysfunction were age, LV wall thickness and moderate-to-severe mitral regurgitation. CONCLUSIONS: In HCM, diastolic dysfunction is present to similar degrees independently from the morphological pattern. The main correlates of diastolic dysfunction are LV obstruction, age, degree of hypertrophy and degree of mitral regurgitation.
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spelling pubmed-40678982014-06-25 How does morphology impact on diastolic function in hypertrophic cardiomyopathy? A single centre experience Finocchiaro, Gherardo Haddad, Francois Pavlovic, Aleksandra Magavern, Emma Sinagra, Gianfranco Knowles, Joshua W Myers, Jonathan Ashley, Euan A BMJ Open Cardiovascular Medicine OBJECTIVES: It is unclear if morphology impacts on diastole in hypertrophic cardiomyopathy (HCM). We sought to determine the relationship between various parameters of diastolic function and morphology in a large HCM cohort. SETTING: Tertiary referral centre from Stanford, California, USA. PARTECIPANTS: 383 patients with HCM and normal systolic function between 1999 and 2011. A group of 100 prospectively recruited age-matched and sex-matched healthy participants were used as controls. PRIMARY AND SECONDARY OUTCOME MEASURES: Echocardiograms were assessed by two blinded board-certified cardiologists. HCM morphology was classified as described in the literature (reverse, sigmoid, symmetric, apical and undefined). RESULTS: Reverse curvature morphology was most commonly observed (218 (57%). Lateral mitral annular E′<12 cm/s was present in 86% of reverse, 88% of sigmoid, 79% of symmetric, 86% of apical and 81% of undefined morphology, p=0.65. E/E′ was similarly elevated (E/E′: 12.3±7.9 in reverse curvature, 12.1±6.1 in sigmoid, 12.7±9.5 in symmetric, 9.4±4.0 in apical, 12.7±7.9 in undefined morphology, p=0.71) and indexed left atrial volume (LAVi)>40 mL/m(2) was present in 47% in reverse curvature, 33% in sigmoid, 32% in symmetric, 37% in apical and 32% in undefined, p=0.09. Each morphology showed altered parameters of diastolic function when compared with the control population. Left ventricular (LV) obstruction was independently associated with all three diastolic parameters considered, in particular with LAVi>40 mL/m(2) (OR 2.04 (95% CI 1.23 to 3.39), p=0.005), E/E′>15 (OR 4.66 (95% CI 2.51 to 8.64), p<0.001) and E′<8 (OR 2.55 (95% CI 1.42 to 4.53), p=0.001). Other correlates of diastolic dysfunction were age, LV wall thickness and moderate-to-severe mitral regurgitation. CONCLUSIONS: In HCM, diastolic dysfunction is present to similar degrees independently from the morphological pattern. The main correlates of diastolic dysfunction are LV obstruction, age, degree of hypertrophy and degree of mitral regurgitation. BMJ Publishing Group 2014-06-12 /pmc/articles/PMC4067898/ /pubmed/24928584 http://dx.doi.org/10.1136/bmjopen-2014-004814 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/
spellingShingle Cardiovascular Medicine
Finocchiaro, Gherardo
Haddad, Francois
Pavlovic, Aleksandra
Magavern, Emma
Sinagra, Gianfranco
Knowles, Joshua W
Myers, Jonathan
Ashley, Euan A
How does morphology impact on diastolic function in hypertrophic cardiomyopathy? A single centre experience
title How does morphology impact on diastolic function in hypertrophic cardiomyopathy? A single centre experience
title_full How does morphology impact on diastolic function in hypertrophic cardiomyopathy? A single centre experience
title_fullStr How does morphology impact on diastolic function in hypertrophic cardiomyopathy? A single centre experience
title_full_unstemmed How does morphology impact on diastolic function in hypertrophic cardiomyopathy? A single centre experience
title_short How does morphology impact on diastolic function in hypertrophic cardiomyopathy? A single centre experience
title_sort how does morphology impact on diastolic function in hypertrophic cardiomyopathy? a single centre experience
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4067898/
https://www.ncbi.nlm.nih.gov/pubmed/24928584
http://dx.doi.org/10.1136/bmjopen-2014-004814
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