Clinical study
Patterns and significance of distribution of left ventricular hypertrophy in hypertrophic cardiomyopathy: A wide angle, two dimensional echocardiographic study of 125 patients

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Abstract

Four patterns of distribution of left ventricular hypertrophy were identified by a wide angle, two dimensional echocardiographic study of 125 patients with hypertrophie Cardiomyopathy. Most commonly (52 percent of patients) hypertrophy involved substantial portions of both the ventricular septum and anterolateral left ventricular free wall (type III). In other patients, hypertrophy was confined to the anterior portion of the ventricular septum (type I), involved the entire ventricular septum but not the left ventricular free wall (type II) or was identified in regions of the left ventricle other than the basal anterior ventricular septum (type IV). In patients with the latter type, conventional M mode echocardiography failed to identify the presence of hypertrophy and therefore the diagnosis of hypertrophic Cardiomyopathy could be established only with two dimensional echocardiography.

Patients with the most widespread hypertrophy involving most of the ventricular septum as well as portions of the free wall (type III) differed from patients having the other patterns of hypertrophy. (1) They more commonly experienced moderate to severe functional limitation (38 of 65 [58 percent]versus 16 of 60 [27 percent]; probability [p] <0.001), and (2) they more often demonstrated obstruction to left ventricular outflow under basal conditions (36 of 65 [55 percent]versus 11 of 60 [18 percent]; p <0.001). Hence, in patients with hypertrophic Cardiomyopathy, wide angle two dimensional echocardiography is capable of detecting myocardial hypertrophy that involves a variety of patterns and is more extensive than may be appreciated with M mode echocardiography. Although left ventricular hypertrophy is “asymmetric” in most patients with hypertrophic Cardiomyopathy, it is usually not confined to the ventricular septum and often involves the anterolateral left ventricular free wall, but it rarely involves the posterior portion of the left ventricular free wall (through which the M mode beam passes).

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