Amplitudes, durations, and timings of apically directed left ventricular myocardial velocities: II. Systolic and diastolic asynchrony in patients with left ventricular hypertrophy

Background: Regional myocardial dysfunction may be the earliest manifestation of myocardial disease and can occur in the absence of abnormalities of global left ventricular (LV) function. The LV long-axis function, which is mainly due to subendocardial muscle fibers, may become abnormal in the presence of normal short-axis function. This study investigates the temporal and spatial characteristics of the LV long-axis function in patients with secondary LV hypertrophy in the presence of normal systolic function. Methods and Results: LV long-axis myocardial velocities were recorded in 18 patients with LV hypertrophy and preserved regional and global systolic function with Doppler tissue imaging. Apically directed myocardial velocities were recorded from the basal, mid, and apical segments of the four LV walls, and their amplitudes, timings, and durations were measured. The abnormalities uncovered by the analysis of regional myocardial velocities included (1) asynchrony in the onset of myocardial contraction circumferentially, (2) presence of postejection LV shortening, (3) asynchrony in the onset of early myocardial lengthening circumferentially, (4) reduced early myocardial lengthening velocity, (5) reduced early to late myocardial lengthening velocity and extents circumferentially, and (6) lack of variation in the basal myocardial velocities circumferentially in contrast to normal individuals. Conclusions: Patients with secondary LV hypertrophy with preserved regional and global systolic performance have distinct abnormalities in the timings and amplitudes of apically directed myocardial velocities. These abnormalities may explain some of the changes in LV global diastolic behavior and may also serve as markers of early regional myocardial dysfunction.