Echokardiografische Gewebedoppleranalyse der Mitralringgeschwindigkeiten bei Patienten mit hypertropher Kardiomyopathie und bei Hochleistungssportlern

Zusammenfassung

Hintergrund und Fragestellung: Ziel dieser Studie war die gewebedopplerechokardiografische Analyse (Tissue Doppler Imaging, TDI) bei Patienten mit nicht obstruktiver hypertropher Kardiomyopathie (HNCM) und bei Leistungssportlern unter Verwendung der in der Literatur vorgeschlagenen Grenzwerte der systolischen (S′-) und frühdiastolischen (E′-)Geschwindigkeiten des Mitralringes (S′ < 9 cm/s, E′ < 9 cm/s) im Hinblick auf die Differenzierung zwischen pathologischen und physiologischen Formen der linksventrikulären Hypertrophie. Patienten und Methoden: Bei 17 Patienten mit HNCM und bei 80 Leistungssportlern wurde konsekutiv eine Analyse der S′- und E′-Geschwindigkeiten des septalen und lateralen Mitralringes mittels TDI durchgeführt. Ergebnisse: Die TDI-Analyse der systolischen Mitralringgeschwindigkeit S′ zeigte bei den HNCM-Patienten im Vergleich zu den Athleten signifikant niedrigerer Werte sowohl im Bereich des septalen Mitralringes (S′ septal: 5,1 ± 1,2 cm/s vs. 9,5 ± 1,5 cm/s, p < 0,001) als auch des lateralen Mitralringes (S′ lateral: 6,4 ± 2,0 cm/s vs. 10,5 ± 2,1 cm/s, p < 0,001). Auch die TDI-Analyse der frühdiastolischen Mitralringgeschwindigkeit E′ zeigte bei HNCM im Vergleich zu den Athleten signifikant niedrige Werte sowohl im Bereich des septalen Mitralringes (E′ septal: 5,9 ± 2,2 cm/s vs.13,1 ± 2,9 cm/s, p < 0,001) als auch des lateralen Mitralringes (E′ lateral: 8,2 ± 3,0 cm/s vs. 16,5 ± 3,4 cm/s, p < 0,001). Schlussfolgerungen: Die Gewebedoppleranalyse der systolischen und (früh-)diastolischen Mitralringbewegung (S′, E′) zeigt bei Patienten mit pathologischer Hypertrophie signifikant erniedrigte Werte und kann daher als sinnvolle Ergänzung im Rahmen der echokardiografischen Diagnostik zur Differenzierung zwischen pathologischen Hypertrophieformen (HNCM) und physiologischen, sportadaptiven Hypertrophieformen bei Leistungssportlern eingesetzt werden.

Abstract

Background and Objective: Echocardiographic Tissue Doppler Imaging (TDI) has been proposed for the differentiation of pathological left ventricular hypertrophy (e. g. hypertrophic cardiomyopathy, HCM) and physiologic left ventricular hypertrophy (athlete’s heart). The aim of this study was the TDI analysis of the systolic (S′) and early diastolic (E′) velocities in patients (pts.) with non-obstructive hypertrophic cardiomyopathy (HCM) and in top-level athletes in consideration of the previously published cut-off values (S′ < 9 cm/s, E′ < 9 cm/s). Patients and Methods: Pulsed-wave TDI of the systolic and early-diastolic velocities was performed at the lateral and septal mitral annulus in the four-chamber view in 17 HCM pts (12 men; mean age 44 ± 16 years) and 80 consecutive athletes (80 men; mean age 26 ± 5 years). Results: Pts with HCM showed significantly decreased systolic velocities of the septal (S′ septal: 5.1 ± 1.2 cm/s versus 9.5 ± 1.5 cm/s, p < 0.001) and lateral mitral annulus (S′ lateral: 6.4 ± 2.0 cm/s vs. 10.5 ± 2.1 cm/s, p < 0.001). The early diastolic velocity of the mitral annulus E′ was significantly decreased in HCM, too (E′ septal: 5.9 ± 2.2 cm/s vs. 13.1 ± 2.9 cm/s, p < 0.001; E′ lateral: 8.2 ± 3.0 cm/s vs. 16.5 ± 3.4 cm/s, p < 0.001). Conclusion: Tissue Doppler Imaging of the systolic and early diastolic velocity of the mitral annulus might be helpful as a promising additional method for the echocardiographic differentiation between pathological and physiologic left ventricular hypertrophy.

Key words

heart - echocardiography - ultrasound power Doppler - ultrasound spectral Doppler - athlete’s heart

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