Transthoracic Doppler Echocardiographic Analysis of Phasic Coronary Blood Flow Velocity in Hypertrophic Cardiomyopathy

Overview

Journal Heart

Date 1997 Jun 1

PMID 9227302

Citations 6

Authors

J J Crowley

P S Dardas

A A Harcombe

L M Shapiro

Affiliations

Soon will be listed here.

Abstract

Objective: To use transthoracic Doppler echocardiography to assess coronary blood flow non-invasively in patients with hypertrophic cardiomyopathy.

Design: High frequency transthoracic Doppler echocardiography was used to assess resting phasic coronary velocity patterns in patients with hypertrophic cardiomyopathy and to define the relation between coronary flow patterns and clinical, echocardiographic, and haemodynamic manifestations of this condition.

Setting: A tertiary referral cardiothoracic centre.

Methods: Fifteen patients (10 men and five women, mean (SD) age 49 (10.3) years) with asymmetric hypertrophic cardiomyopathy underwent high frequency (5 MHz) transthoracic Doppler echocardiographic assessment of the left anterior descending coronary artery. In addition, standard two dimensional echocardiography was performed. The results were compared with 16 normal participants (nine men and seven women, mean age 61.2 (10.7) years) who had no evidence of cardiac disease.

Results: Biphasic diastolic predominant coronary artery blood velocity profiles were obtained in all patients and controls. Systolic peak blood velocity and velocity time integral were significantly reduced in the hypertrophic cardiomyopathy group compared with controls (11.3 (15.8) cm/s and 1.09 (1.78) cm v 20.5 (13.1) cm/s and 4.23 (2.80) cm, respectively, P < 0.05). A reversed pattern of systolic blood flow velocity was found in three patients with severe anterior wall and septal hypertrophy. During diastole there was prolongation of the diastolic acceleration (203 (53) ms v 110 (60) ms in controls, P < 0.05) and deceleration times (487 (200) ms v 210 (90) ms in controls, P < 0.05). There was no significant difference between those with and without symptoms or a left ventricular outflow tract gradient.

Conclusions: Patients with hypertrophic cardiomyopathy have abnormal systolic and diastolic coronary flow profiles at rest when measured by transthoracic echocardiography.

Citing Articles

Phasic flow patterns of right versus left coronary arteries in patients undergoing clinical physiological assessment.

Seligman H, Nijjer S, van de Hoef T, de Waard G, Mejia-Renteria H, Echavarria-Pinto M EuroIntervention. 2021; 17(15):1260-1270.

PMID: 34338643 PMC: 9724998. DOI: 10.4244/EIJ-D-21-00189.

Diastolic flow velocity pattern of the left anterior descending coronary artery in hypertrophied heart, with special reference to the difference between hypertrophic cardiomyopathy and hypertensive left ventricular hypertrophy.

Fukuda N, Fukuda Y, Morishita S, Sakabe K, Shinohara H, Tamura Y J Echocardiogr. 2016; 8(2):45-51.

PMID: 27278660 DOI: 10.1007/s12574-009-0031-3.

Transthoracic Doppler echocardiography - noninvasive diagnostic window for coronary flow reserve assessment.

Dimitrow P Cardiovasc Ultrasound. 2003; 1:4.

PMID: 12740038 PMC: 155634. DOI: 10.1186/1476-7120-1-4.

Systolic compression of epicardial coronary and intramural arteries in children with hypertrophic cardiomyopathy.

Mohiddin S, Fananapazir L Tex Heart Inst J. 2002; 29(4):290-8.

PMID: 12484613 PMC: 140291.

Effect of verapamil on systolic and diastolic coronary blood flow velocity in asymptomatic and mildly symptomatic patients with hypertrophic cardiomyopathy.

Dimitrow P, KRZANOWSKI M, Nizankowski R, Szczeklik A, Dubiel J Heart. 2000; 83(3):262-6.

PMID: 10677401 PMC: 1729332. DOI: 10.1136/heart.83.3.262.

References

Hatle L . Noninvasive assessment and differentiation of left ventricular outflow obstruction with Doppler ultrasound. Circulation. 1981; 64(2):381-7. DOI: 10.1161/01.cir.64.2.381. View

GILBERT B, Pollick C, Adelman A, Wigle E . Hypertrophic cardiomyopathy: subclassification by m mode echocardiography. Am J Cardiol. 1980; 45(4):861-72. DOI: 10.1016/0002-9149(80)90133-2. View

Hanrath P, Mathey D, Montz R, Thiel U, Vorbringer H, Kupper W . Myocardial thallium 201 imaging in hypertrophic obstructive cardiomyopathy. Eur Heart J. 1981; 2(3):177-85. DOI: 10.1093/oxfordjournals.eurheartj.a061192. View

PASTERNAC A, Noble J, Streulens Y, Elie R, Henschke C, Bourassa M . Pathophysiology of chest pain in patients with cardiomyopathies and normal coronary arteries. Circulation. 1982; 65(4):778-89. DOI: 10.1161/01.cir.65.4.778. View

Chilian W, Marcus M . Phasic coronary blood flow velocity in intramural and epicardial coronary arteries. Circ Res. 1982; 50(6):775-81. DOI: 10.1161/01.res.50.6.775. View

Opherk D, Mall G, Zebe H, Schwarz F, Weihe E, Manthey J . Reduction of coronary reserve: a mechanism for angina pectoris in patients with arterial hypertension and normal coronary arteries. Circulation. 1984; 69(1):1-7. DOI: 10.1161/01.cir.69.1.1. View

Cannon 3rd R, Rosing D, Maron B, Leon M, Bonow R, Watson R . Myocardial ischemia in patients with hypertrophic cardiomyopathy: contribution of inadequate vasodilator reserve and elevated left ventricular filling pressures. Circulation. 1985; 71(2):234-43. DOI: 10.1161/01.cir.71.2.234. View

Tanaka M, Fujiwara H, Onodera T, Wu D, Hamashima Y, Kawai C . Quantitative analysis of myocardial fibrosis in normals, hypertensive hearts, and hypertrophic cardiomyopathy. Br Heart J. 1986; 55(6):575-81. PMC: 1236764. DOI: 10.1136/hrt.55.6.575. View

Maron B, Wolfson J, Epstein S, Roberts W . Intramural ("small vessel") coronary artery disease in hypertrophic cardiomyopathy. J Am Coll Cardiol. 1986; 8(3):545-57. DOI: 10.1016/s0735-1097(86)80181-4. View

10.

St John Sutton M, Lie J, Anderson K, OBrien P, Frye R . Histopathological specificity of hypertrophic obstructive cardiomyopathy. Myocardial fibre disarray and myocardial fibrosis. Br Heart J. 1980; 44(4):433-43. PMC: 482424. DOI: 10.1136/hrt.44.4.433. View

11.

Tomoike H, Ootsubo H, Sakai K, Kikuchi Y, Nakamura M . Continuous measurement of coronary artery diameter in situ. Am J Physiol. 1981; 240(1):H73-9. DOI: 10.1152/ajpheart.1981.240.1.H73. View

12.

Pitcher D, Wainwright R, Maisey M, Curry P, Sowton E . Assessment of chest pain in hypertrophic cardiomyopathy using exercise thallium-201 myocardial scintigraphy. Br Heart J. 1980; 44(6):650-6. PMC: 482461. DOI: 10.1136/hrt.44.6.650. View

13.

Pichard A, Gorlin R, Smith H, Ambrose J, Meller J . Coronary flow studies in patients with left ventricular hypertrophy of the hypertensive type. Evidence for an impaired coronary vascular reserve. Am J Cardiol. 1981; 47(3):547-54. DOI: 10.1016/0002-9149(81)90537-3. View

14.

Wigle E . Hypertrophic cardiomyopathy: a 1987 viewpoint. Circulation. 1987; 75(2):311-22. DOI: 10.1161/01.cir.75.2.311. View

15.

Maron B, Bonow R, Cannon 3rd R, Leon M, Epstein S . Hypertrophic cardiomyopathy. Interrelations of clinical manifestations, pathophysiology, and therapy (1). N Engl J Med. 1987; 316(13):780-9. DOI: 10.1056/NEJM198703263161305. View

16.

Maron B, Bonow R, Cannon 3rd R, Leon M, Epstein S . Hypertrophic cardiomyopathy. Interrelations of clinical manifestations, pathophysiology, and therapy (2). N Engl J Med. 1987; 316(14):844-52. DOI: 10.1056/NEJM198704023161405. View

17.

Maron B, Spirito P, Green K, Wesley Y, Bonow R, Arce J . Noninvasive assessment of left ventricular diastolic function by pulsed Doppler echocardiography in patients with hypertrophic cardiomyopathy. J Am Coll Cardiol. 1987; 10(4):733-42. DOI: 10.1016/s0735-1097(87)80264-4. View

18.

Lewis B, JAMES E, Welch T . Current applications of duplex and color Doppler ultrasound imaging: carotid and peripheral vascular system. Mayo Clin Proc. 1989; 64(9):1147-57. DOI: 10.1016/s0025-6196(12)64984-2. View

19.

Houghton J, Frank M, CARR A, von Dohlen T, Prisant L . Relations among impaired coronary flow reserve, left ventricular hypertrophy and thallium perfusion defects in hypertensive patients without obstructive coronary artery disease. J Am Coll Cardiol. 1990; 15(1):43-51. DOI: 10.1016/0735-1097(90)90173-m. View

20.

Miyatake K, Yamagishi M, Izumi S, Beppu S, Yamamoto K, Sakakibara H . Doppler echocardiographic approach to the blood flow of the left anterior descending coronary artery. J Clin Ultrasound. 1988; 16(7):471-81. DOI: 10.1002/jcu.1870160704. View