Isolated hypertrophy of the basal ventricular septum: Characteristics of patients with and without outflow tract obstruction

Abstract Background Isolated basal septal hypertrophy (IBSH) of the left ventricle (LV) is not a well understood phenomenon, particularly in the presence of concomitant left ventricular outflow tract obstruction (LVOTO). We evaluated the prevalence of IBSH and compared those with and without LVOTO....

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Bibliographic Details
Published in:International journal of cardiology 2014-05, Vol.173 (3), p.487-493
Main Authors: Ranasinghe, Isuru, Ayoub, Chadi, Cheruvu, Chaitu, Freedman, Saul B, Yiannikas, John
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Biological and medical sciences
Cardiac hypertrophy
Cardiology. Vascular system
Cardiovascular
Cohort Studies
Epidemiology
Female
Heart
Humans
Hypertrophy, Left Ventricular - diagnostic imaging
Hypertrophy, Left Ventricular - epidemiology
Male
Medical sciences
Middle Aged
Outflow tract obstruction
Retrospective Studies
Sigmoid septum
Ultrasonography
Ventricular Outflow Obstruction - diagnostic imaging
Ventricular Outflow Obstruction - epidemiology
Ventricular Septum - diagnostic imaging
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Summary:Abstract Background Isolated basal septal hypertrophy (IBSH) of the left ventricle (LV) is not a well understood phenomenon, particularly in the presence of concomitant left ventricular outflow tract obstruction (LVOTO). We evaluated the prevalence of IBSH and compared those with and without LVOTO. Methods Retrospective observational study of 4104 consecutive patients undergoing echocardiography at a community cardiology practice and a hospital without specialized Hypertrophic Cardiomyopathy (HCM) service to determine prevalence of IBSH, defined as isolated hypertrophy (> 15 mm) of the basal LV septum (BS) without hypertrophy elsewhere. Clinical, ECG and echocardiographic characteristics were compared in IBSH with and without LVOTO. Results Prevalence of IBSH was 5.8% (240/4104): mean (SD) age was 76.0y (10.4) with equal gender distribution. Prevalence increased with age (p < 0.001 for trend), reaching 7.8% over 70y. None had a family history of HCM, and HCM-associated ECG changes were uncommon. Mean BS thickness (SD) was 17.8 mm (0.24) with a BS/posterior wall ratio (SD) of 1.76 (0.31). Resting peak LVOT gradient (> 20 mm Hg) was present in 8/240 (3.3%), mean (SD) 69.6mm Hg (59.3). Patients with LVOTO had hypercontractile LV function (fractional shortening [SD] 51.8% [9.5] vs. 40.5% [10.9], p = 0.012) compared to those without LVOTO, but had similar BS thickness [SD] (17.8 mm [3.0] vs. 17.8 mm [2.8], p = 0.996) and ECG characteristics. Greater apical and septal displacements of the mitral valve co-aptation point characterized those with IBSH and LVOTO. Conclusions IBSH is common in elderly patients referred for echocardiography. LVOTO occurs only when concomitant mitral valve co-aptation and LV hypercontractility facilitate development of a gradient, rather than through differences in the degree of BS myocardial hypertrophy.
ISSN:0167-5273
1874-1754
DOI:10.1016/j.ijcard.2014.03.078