INTRAVENTRICULAR SYSTOLIC FLOW MAPPING IN HYPERTROPHIC CARDIOMYOPATHY

Ninety-two consecutive patients with hypertrophic cardiomyopathy were studied with pulsed and continuous-wave Doppler and color flow imaging to assess the intraventricular systolic flow profile from apex to base and compare it with that obtained in normals and in patients with aortic stenosis and systemic hypertension. Hypertrophic cardiomyopathy patients had higher intraventricular blood flow velocities (cm/sec) from apex to base compared with normals and aortic stenosis and systemic hypertension patients (apex: 41.5 +/- 17.3 vs 24 +/- 1.9, 26.1 +/- 2.9, and 26.4 +/- 3.3; papillary muscles: 95.4 +/- 66.5 vs 41.9 +/- 4.9, 46.2 +/- 3.4, and 46.4 +/- 5.7; outflow tract: 249.3 +/- 1762 vs 66.9 +/- 8.4, 64.1 +/- 10.8, and 66 +/- 9.5, respectively) (P < 0.001). Eighty-six (93%) hypertrophic cardiomyopathy patients showed an abnormal intraventricular systolic color flow pattern at one or more sites but none of the patients with aortic stenosis or systemic hypertension or normal controls. Of those, 65 (71%) showed one or more variant (mosaic) flow, all of whom had intraventricular gradients, while 75 showed abnormal aliased flow at a site other than the subaortic area. It is concluded that patients with hypertrophic cardiomyopathy often exhibit an abnormal spatial distribution of the intraventricular systolic flow velocity profile compared with normals and patients with secondary forms of ventricular hypertrophy that can readily be recognized with color flow imaging. This could improve the sometimes difficult separation of hypertrophic cardiomyopathy patients from secondary hypertrophy.