Objectives: It is unclear if morphology impacts on
diastole in hypertrophic cardiomyopathy (HCM). We
sought to determine the relationship between various
parameters of diastolic function and morphology in a
large HCM cohort.
Setting: Tertiary referral centre from Stanford,
California, USA.
Partecipants: 383 patients with HCM and normal
systolic function between 1999 and 2011. A group of
100 prospectively recruited age-matched and sexmatched
healthy participants were used as controls.
Primary and secondary outcome measures:
Echocardiograms were assessed by two blinded boardcertified
cardiologists. HCM morphology was classified
as described in the literature (reverse, sigmoid,
symmetric, apical and undefined).
Results: Reverse curvature morphology was most
commonly observed (218 (57%). Lateral mitral annular
E′<12 cm/s was present in 86% of reverse, 88% of
sigmoid, 79% of symmetric, 86% of apical and 81% of
undefined morphology, p=0.65. E/E′ was similarly
elevated (E/E′: 12.3±7.9 in reverse curvature, 12.1±6.1
in sigmoid, 12.7±9.5 in symmetric, 9.4±4.0 in apical,
12.7±7.9 in undefined morphology, p=0.71) and
indexed left atrial volume (LAVi)>40 mL/m2 was
present in 47% in reverse curvature, 33% in sigmoid,
32% in symmetric, 37% in apical and 32% in
undefined, p=0.09. Each morphology showed altered
parameters of diastolic function when compared with
the control population. Left ventricular (LV) obstruction
was independently associated with all three diastolic
parameters considered, in particular with LAVi>40 mL/
m2 (OR 2.04 (95% CI 1.23 to 3.39), p=0.005), E/E′>15
(OR 4.66 (95% CI 2.51 to 8.64), p<0.001) and E′<8
(OR 2.55 (95% CI 1.42 to 4.53), p=0.001). Other
correlates of diastolic dysfunction were age, LV wall
thickness and moderate-to-severe mitral regurgitation.
Conclusions: In HCM, diastolic dysfunction is present
to similar degrees independently from the
morphological pattern. The main correlates of diastolic
dysfunction are LV obstruction, age, degree of
hypertrophy and degree of mitral regurgitation.
