This Article Full Text Full Text (PDF) All Versions of this Article: 109/14/1756    most recent 01.CIR.0000124723.16433.31v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by McMahon, C. J. Articles by Eidem, B. W. Search for Related Content PubMed PubMed Citation Articles by McMahon, C. J. Articles by Eidem, B. W. Related Collections Cardiovascular imaging agents/Techniques Myocardial cardiomyopathy disease Echocardiography Doppler ultrasound, Transcranial Doppler etc.

(Circulation. 2004;109:1756-1762.)
© 2004 American Heart Association, Inc.

Clinical Investigation and Reports

Characterization of Left Ventricular Diastolic Function by Tissue Doppler Imaging and Clinical Status in Children With Hypertrophic Cardiomyopathy

Colin J. McMahon, MB, MRCPI; Sherif F. Nagueh, MD; Ricardo H. Pignatelli, MD; Susan W. Denfield, MD; William J. Dreyer, MD; Jack F. Price, MD; Sarah Clunie, RN; Louis I. Bezold, MD; Amanda L. Hays, MEd; Jeffrey A. Towbin, MD; Benjamin W. Eidem, MD

From the Lillie Frank Abercrombie Section of Pediatric Cardiology (C.J.M., R.H.P., S.W.D., W.J.D., J.F.P., S.C., L.I.B., A.L.H., J.A.T., B.W.E.), Texas Children’s Hospital, and Section of Cardiology, Department of Medicine (S.F.N.), Methodist Hospital, Baylor College of Medicine, Houston, Tex.

Reprint requests to Benjamin W. Eidem, MD, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children’s Hospital, Houston, TX 77030. E-mail beidem{at}bcm.tmc.edu

Received May 19, 2003; de novo received September 16, 2003; revision received January 9, 2004; accepted January 27, 2004.

Background— Conventional transmitral Doppler indices are unreliable in assessing clinical status in patients with hypertrophic cardiomyopathy (HCM) because they are affected by loading conditions. This study sought to determine whether tissue Doppler velocities are predictive of adverse clinical outcomes including death, cardiac arrest, ventricular tachycardia (VT), significant cardiac symptoms, and exercise capacity in children with HCM.

Methods and Results— We studied 80 consecutive children (median age 12 years, median follow-up 26 months) evaluated at 1 hospital from January 1999 to August 2003 compared with 80 age- and gender-matched controls. Patients underwent echocardiography, ambulatory Holter monitoring, and upright exercise testing. Children with HCM had significantly decreased early diastolic tissue Doppler velocities at the lateral mitral (13.2 versus 19.3 cm/s), tricuspid (13.3 versus 16.3 cm/s), and septal (9.4 versus 13.5 cm/s) annuli compared with controls (P<0.001 for each comparison). By forward stepwise regression analysis, early transmitral left ventricular filling velocity (E)/septal Ea ratio predicted death, cardiac arrest, or VT (r=0.610, R²=0.37, P<0.001). Peak oxygen consumption (O₂) was most predictive of children who developed symptoms (r=0.427, R²=0.182, P<0.001). Peak O₂ correlated inversely with E/Ea septal ratio (r=–0.740, P<0.01).

Conclusions— Transmitral E/septal Ea ratio predicts children with HCM who are at risk of adverse clinical outcomes including death, cardiac arrest, VT, and significant cardiac symptoms. Peak O₂ correlated with peak exercise capacity in HCM patients.

Key Words: cardiomyopathy • echocardiography • pediatrics

This article has been cited by other articles:

				M. V. Sherrid, O. Wever-Pinzon, A. Shah, and F. A. Chaudhry Reflections of inflections in hypertrophic cardiomyopathy. J. Am. Coll. Cardiol., July 14, 2009; 54(3): 212 - 219. [Abstract] [Full Text] [PDF]

				J. A. Decker, J. W. Rossano, E. O. Smith, B. Cannon, S. K. Clunie, C. Gates, J. L. Jefferies, J. J. Kim, J. F. Price, W. J. Dreyer, et al. Risk factors and mode of death in isolated hypertrophic cardiomyopathy in children. J. Am. Coll. Cardiol., July 14, 2009; 54(3): 250 - 254. [Abstract] [Full Text] [PDF]

				I A Paraskevaidis, F Panou, C Papadopoulos, D Farmakis, J Parissis, I Ikonomidis, A Rigopoulos, E K Iliodromitis, and D Th Kremastinos Evaluation of left atrial longitudinal function in patients with hypertrophic cardiomyopathy: a tissue Doppler imaging and two-dimensional strain study Heart, March 15, 2009; 95(6): 483 - 489. [Abstract] [Full Text] [PDF]

				S. F. Nagueh, C. P. Appleton, T. C. Gillebert, P. N. Marino, J. K. Oh, O. A. Smiseth, A. D. Waggoner, F. A. Flachskampf, P. A. Pellikka, and A. Evangelisa Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography Eur J Echocardiogr, March 1, 2009; 10(2): 165 - 193. [Full Text] [PDF]

				J. Ganame, R. H. Pignatelli, B. W. Eidem, P. Claus, J. D'hooge, C. J. McMahon, G. Buyse, J. A. Towbin, N. A. Ayres, and L. Mertens Myocardial deformation abnormalities in paediatric hypertrophic cardiomyopathy: are all aetiologies identical? Eur J Echocardiogr, November 1, 2008; 9(6): 784 - 790. [Abstract] [Full Text] [PDF]

				J P Kaski, M T Tome-Esteban, S Mead-Regan, A Pantazis, J Marek, J E Deanfield, W J McKenna, and P M Elliott B-type natriuretic peptide predicts disease severity in children with hypertrophic cardiomyopathy Heart, October 1, 2008; 94(10): 1307 - 1311. [Abstract] [Full Text] [PDF]

				F. Bayrak, G. Kahveci, B. Mutlu, K. Sonmez, and M. Degertekin Tissue Doppler imaging to predict clinical course of patients with hypertrophic cardiomyopathy Eur J Echocardiogr, March 1, 2008; 9(2): 278 - 283. [Abstract] [Full Text] [PDF]

				J. Ganame, L. Mertens, B. W. Eidem, P. Claus, J. D'hooge, L. M. Havemann, C. J. McMahon, M. A. A. Elayda, W. K. Vaughn, J. A. Towbin, et al. Regional myocardial deformation in children with hypertrophic cardiomyopathy: morphological and clinical correlations Eur. Heart J., December 1, 2007; 28(23): 2886 - 2894. [Abstract] [Full Text] [PDF]

				C. J McMahon, R. H Pignatelli, S. F Nagueh, V.-V. Lee, W. Vaughn, S. O Valdes, J. P Kovalchin, J Lynn Jefferies, W. J Dreyer, S. W Denfield, et al. Left ventricular non-compaction cardiomyopathy in children: characterisation of clinical status using tissue Doppler-derived indices of left ventricular diastolic relaxation Heart, June 1, 2007; 93(6): 676 - 681. [Abstract] [Full Text] [PDF]

				H Okura, Y Takada, T Kubo, K Iwata, S Mizoguchi, H Taguchi, I Toda, J Yoshikawa, and K Yoshida Tissue Doppler-derived index of left ventricular filling pressure, E/E', predicts survival of patients with non-valvular atrial fibrillation Heart, September 1, 2006; 92(9): 1248 - 1252. [Abstract] [Full Text] [PDF]

				T. G. Neilan, D. M. Yoerger, P. S. Douglas, J. E. Marshall, E. F. Halpern, D. Lawlor, M. H. Picard, and M. J. Wood Persistent and reversible cardiac dysfunction among amateur marathon runners Eur. Heart J., May 1, 2006; 27(9): 1079 - 1084. [Abstract] [Full Text] [PDF]