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Diastolic Abnormalities as the First Feature of Hypertrophic Cardiomyopathy in Dutch Myosin-Binding Protein C Founder Mutations

Michelle Michels, MD^_*, Osama I.I. Soliman, MD, PhD^_*, Marcel J. Kofflard, MD, PhD, Yvonne M. Hoedemaekers, MD, Dennis Dooijes, PhD, Danielle Majoor-Krakauer, MD, PhD, Folkert J. ten Cate, MD, PhD^_*,_*

^_* Department of Cardiology, Thoraxcenter, Erasmus University Medical Center Rotterdam, the Netherlands
Department of Clinical Genetics, Thoraxcenter, Erasmus University Medical Center Rotterdam, the Netherlands
Department of Albert Schweitzer Hospital, Dordrecht, the Netherlands

^_* Reprint requests and correspondence: Dr. Folkert J. ten Cate, Erasmus MC, Department of Cardiology, Thoraxcenter, Room Ba 304, Dr. Molewaterplein 40, Rotterdam 3015 GD, the Netherlands (Email: f.j.tencate{at}erasmusmc.nl).

Objectives: To test the hypothesis that carriers of Dutch founder mutations in cardiac myosin-binding protein C (MYBPC3), without left ventricular hypertrophy (LVH) or electrocardiographic abnormalities, have diastolic dysfunction on tissue Doppler imaging (TDI), which can be used for the screening of family members in the hypertrophic cardiomyopathy (HCM) population.

Background: TDI is a more sensitive technique for the assessment of left ventricular contraction and relaxation abnormalities than is conventional echocardiography.

Methods: Echocardiographic studies including TDI were performed in genotyped hypertrophic cardiomyopathy patients (genotype-positive, G+/LVH+; n = 27), mutation carriers without LVH (G+/LVH–; n = 27), and healthy controls (n = 55). The identified mutations in MYBPC3 in the G+/LVH+ subjects were c.2864_2865delCT (12 subjects), c.2373dupG (n = 8), and p. Arg943X (n = 7). In the G+/LVH– subjects, the following mutations were identified: c.2864_2865delCT (n = 11), c.2373dupG (n = 8), and p. Arg943X (n = 8).

Results: Mean TDI-derived systolic and early and late diastolic mitral annular velocities were significantly lower in the G+/LVH+ subjects compared with the other groups. However, there was no difference between controls and G+/LVH– subjects. Mean TDI-derived late mitral annular diastolic velocities were significantly higher in the G+/LVH– subjects compared with controls and G+/LVH+ subjects. Using a cut-off value of mean ± 2 SD, an abnormal late mitral annular diastolic velocity was found in 14 (51%) of G+/LVH– patients. There was no difference among the 3 different mutations.

Conclusions: In contrast to earlier reports, mean mitral annular systolic velocity and early mitral annular diastolic velocity velocities were not reduced in G+/LVH– subjects, and TDI velocities were not sufficiently sensitive for determination of the affected status of an individual subject. Our findings, however, support the theory that diastolic dysfunction is a primary component of pre-clinical HCM.

Key Words: tissue Doppler imaging • hypertrophic cardiomyopathy • myosin-binding protein C

Abbreviations and Acronyms   A = late LV filling velocity   Aa = late mitral annular diastolic velocity   E = early LV filling velocity   Ea = early mitral annular diastolic velocity   G = genotype   HCM = hypertrophic cardiomyopathy   LVH = left ventricular hypertrophy   MYBPC3 = cardiac myosin-binding protein C   Sa = mitral annular systolic velocity   TDI = tissue Doppler imaging

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Barry J. Maron and Carolyn Y. Ho
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