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Nuklearmedizin 1985; 24(05): 196-200
DOI: 10.1055/s-0038-1624302
Originalarbeiten - Original Articles
Schattauer GmbH

Hypertrophic Cardiomyopathy: Non-Invasive Assessment of Diastolic and Systolic Functional Parameters in Relation to Heart Rate

Hypertrophe Kardiomyopathie: Nichtinvasive Erfassung diastolischer und systolischer Funktionsparameter in Beziehung zur Herzfrequenz
C. A. Nienaber
1   From the Departments of Cardiology, University Hospital Eppendorf, Hamburg, Federal Republic of Germany
,
R. P. Spielmann
*   From the Departments of Cardiology and Nuclear Medicine, University Hospital Eppendorf, Hamburg, Federal Republic of Germany
,
M. Geiger
1   From the Departments of Cardiology, University Hospital Eppendorf, Hamburg, Federal Republic of Germany
,
A. Clausen
1   From the Departments of Cardiology, University Hospital Eppendorf, Hamburg, Federal Republic of Germany
,
K.-H. Kuck
1   From the Departments of Cardiology, University Hospital Eppendorf, Hamburg, Federal Republic of Germany
,
R. Montz
*   From the Departments of Cardiology and Nuclear Medicine, University Hospital Eppendorf, Hamburg, Federal Republic of Germany
› Author Affiliations
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Publication History

Received: 25 September 1985

Publication Date:
12 January 2018 (online)

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Summary

Hypertrophic cardiomyopathy (HC) is characterized by reduced left ventricular compliance and subsequent filling abnormalities. To study the pathophysiologic changes in parameters of left ventricular systolic and diastolic performance as a function of increasing heart rate 14 patients with HC (32 ± 12 yrs; 11 M, 4 F) and 4 normal individuals were subjected to equilibrium radionuclide ventriculography (99mTc-labelled red blood cells) at rest and during incremental right atrial pacing; heart rate was increased in steps of 20 beats per min from basal state to the individual symptom-limited endpoint. Mean symptom-limited heart rate was 141 ± 28 in HC and 160 in normals (p <.01.). At each pacing level filling and ejection parameters as well as the left ventricular endsystolic (LVESV) and enddiastolic volume (LVEDV) were determined relative to resting volumes at a heart rate of 78 ± 8. At the individual maximal pacing rate HC revealed a decline in LVEDV to 61 ± 4 % (p C.001) and an increase in LVESV to 117 ± 14% (p <.001) resulting in decreasing ejection fractions at heart rates above 120. Peak LV filling rates initially increased but subsequently decreased steeply at heart rates above 100; peak LV ejection rates in HC showed a similar pattern with increasing frequency. Time inter- vais to peak ejection and peak filling rate did not differ from normal. Thus, patients with HC demonstrated combined left ventricular diastolic and systolic abnormalities with increasing heart rate leading into a low-input low-output circulatory state. This probably explains not only the symptoms associated with HC, but also supports the concept of “hemodynamic syncope” in HC.

Zusammenfassung

Die hypertrophische Kardiomyopathie (HCM) ist durch eine reduzierte diastolische Compliance mit Störung der linksventrikulären Füllung gekennzeichnet. Ziel dieser Studie war es, auf nichtinvasive Weise die pathophysiologischen Veränderungen der diastolischen und systolischen Funktion des linken Ventrikels bei zunehmender Herzfrequenz zu analysieren. Vierzehn Patienten mit HCM (32 ± 12 Jahre; 11M, 3 F) und 4 Normalpersonen wurden mittels Äquilibrium- Radionuklidventrikulographie (99m Tcmarkierte Erythrozyten) unter Ruhebedingungen und während rechtsatrialer Frequenzstimulation untersucht. Die Herzfrequenz wurde in Schritten von 20 Schlägen/min bis zum individuellen symptomlimitierten Endpunkt gesteigert. Die maximal erreichbare Frequenz bei HCM war 141 ± 28, bei Normalpersonen 160 (p C.Ol). Auf jeder Stimulationsstufe wurden s sowohl Füllungs- und Auswurfparameter als auch das linksventrikuläre endsystolische (LVESV) und enddiastolische Volumen (LVEDV) relativ zum Ruhewert bei einer Frequenz von 72 ± 8 gemessen. Mit steigender Stimulationsfrequenz war HCM durch ein abfallendes LVEDV auf 61 ± 4% (p <.001) und durch ein ansteigendes LVESV auf 117 ± 14% (p C.001) gekennzeichnet, was in einer sinkenden Auswurffraktion bei Frequenzen über 120 resultierte. Die maximale LV Füllungsrate fiel bereits bei einer Frequenz von 100 ab; die maximale LV Auswurfrate zeigte ein ähnliches Verhalten bei steigender Herzfrequenz. Die Zeitintervalle bis zur maximalen Auswurf- und Füllungsrate unterschieden sich nicht von Normalpersonen.

* Herrn Prof. Dr. med. C. Schneider zum 60. Geburtstag.


 

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