Author + information
- Received July 23, 2008
- Revision received August 14, 2008
- Accepted August 19, 2008
- Published online January 1, 2009.
- 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† and
- Folkert J. ten Cate, MD, PhD⁎,⁎ ()
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
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.
- Received July 23, 2008.
- Revision received August 14, 2008.
- Accepted August 19, 2008.
- American College of Cardiology Foundation