Hypertensive Hypertrophic Cardiomyopathy of the Elderly

Abstract

Using echocardiography, we identified 21 patients with a syndrome that included severe concentric cardiac hypertrophy, a small left ventricular cavity, and supernormal indexes of systolic function without concurrent medical illness or ischemic heart disease. Thirteen of the patients presented with dyspnea or chest pain. All patients studied had a history of hypertension and were compared with normotensive controls matched for age and sex. The patients were elderly (mean age, 73.3 years), predominantly female (16 patients), and mostly black (15 patients). Their cardiac function was characterized by excessive left ventricular emptying (ejection fraction on two-dimensional echocardiography [patients vs. controls], 79 +/- 4 vs. 59 +/- 5 per cent, P less than 0.001) and abnormal diastolic function as manifested by a prolonged early diastolic filling period (279 +/- 25 vs. 160 +/- 45 msec, P less than 0.001) and reduced peak diastolic dimension increase (11 +/- 4 vs. 16 +/- 5 cm per second, P less than 0.05). In spite of the clinical presentation of heart failure, all of 9 patients receiving either beta-receptor antagonists or calcium-channel blocking agents obtained symptomatic relief, whereas 6 of 12 patients receiving vasodilator medications had severe hypotensive reactions, including one death. We conclude that this unique subset of hypertensive patients has a clinical syndrome that warrants recognition and tailored management.

Progression of asymmetric pattern of left ventricular hypertrophy in patients with hypertrophic cardiomyopathy accompanied by hypertension in the elderly

“…Therefore, authors 2 proposed that this condition might be better termed HCM with hypertension rather than hypertensive HCM as this syndrome was previously labelled by Topol et al 3 Our findings support this proposal, because we have shown that this asymmetric LVH pattern (common for isolated HCM) was present in both younger and older HCM patients with hypertension. Moreover, asymmetric distribution of LVH aggravated with increasing age in HCM with hypertensive patients.…”

“…Previous studies [1][2][3][4] provided conflicting data concerning which type of LVH pattern (asymmetric or concentric) predominated in HCM with hypertension patients. In the most populous study of Lewis and Maron, 1 the predominance of the asymmetric LVH pattern and the magnitude of asymmetry was similar between normotensive and hypertensive HCM patients in the elderly.…”

“…The frequency of hypertension as a concomitant disease to HCM varied in previous studies among elderly patients and ranged from one-third to two-thirds of HCM patients studied. [1][2][3][4] Those reports [1][2][3][4] provided conflicting data concerning the type of left ventricular hypertrophy (LVH) pattern, ie, asymmetric or concentric predominated in HCM with hypertension patients. In the face of these equivocal findings, we decided to explore the problem of the potential influence of hypertension overlapping on HCM by comparing the LVH pattern between younger and older HCM with hypertension patients.…”

Hypertrophic Cardiomyopathy With Midventricular Obstruction and Apical Aneurysm. A Case Report.

“…HCM has been reported to have some variants with atypical features in elderly women and one of them is characterized by severe concentric left ventricular hypertrophy with a history of systemic hypertension and abnormal left ventricular diastolic function; 12 another is characterized by obstructive HCM with submitral annular calcification. 13 However, the present case did not have either of these 2 variations.…”

Early Detection of Right Ventricular Dysfunction by Myocardial Performance Index in Diabetic Patients

“…5 Several studies using echocardiography have demonstrated deterioration in left ventricular diastolic properties in diabetic patients. [6][7][8][9] RV function has proven to be of importance for risk stratification in heart failure and is associated with sudden death and exercise limitation . 10 RV function has not been studied in depth yet in diabetic patients although the RV has an important contribution to the overall cardiac function .…”