Analysis of transmural trend of myocardial integrated ultrasound backscatter for differentiation of hypertrophic cardiomyopathy and ventricular hypertrophy due to hypertension.

OBJECTIVES This study was undertaken to differentiate hypertrophic cardiomyopathy from hypertensive hypertrophy using a newly developed M-mode format integrated backscatter imaging system capable of calibrating myocardial integrated backscatter with the power of Doppler signals from the blood. BACKGROUND Myocardial integrated ultrasound backscatter changes in patients with hypertrophic cardiomyopathy; however, it is unknown whether ultrasound myocardial tissue characterization may be useful in differentiating hypertrophic cardiomyopathy from hypertensive hypertrophy. METHODS Calibrated myocardial integrated backscatter and its transmural gradient were measured in the septum and posterior wall in 31 normal subjects, 13 patients with hypertensive hypertrophy and 22 patients with hypertrophic cardiomyopathy. The gradient in integrated backscatter was determined as the ratio of calibrated integrated backscatter in the endocardial half to that in the epicardial half of the myocardium. RESULTS Cyclic variation of integrated backscatter was smaller and calibrated myocardial integrated backscatter higher in patients with hypertrophied hearts than in normal subjects, but there were no significant differences in either integrated backscatter measure between patients with hypertensive hypertrophy and those with hypertrophic cardiomyopathy. Transmural gradient in myocardial integrated backscatter was present only in patients with hypertrophic cardiomyopathy (5.0 +/- 1.8 dB [mean +/- SD] for the septum; 1.2 +/- 1.6 dB for the posterior wall). CONCLUSIONS Hypertrophic cardiomyopathy and ventricular hypertrophy due to hypertension can be differentiated on the basis of quantitative analysis of the transmural gradient in integrated backscatter.

[1]  N. Reichek,et al.  Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. , 1986, The American journal of cardiology.

[2]  J. G. Miller,et al.  Effects of myocardial contraction on ultrasonic backscatter before and after ischemia. , 1984, The American journal of physiology.

[3]  I Schnittger,et al.  Ultrasonic tissue characterization with a real time integrated backscatter imaging system in normal and aging human hearts. , 1989, Journal of the American College of Cardiology.

[4]  A J Tajik,et al.  Feasibility of identifying amyloid and hypertrophic cardiomyopathy with the use of computerized quantitative texture analysis of clinical echocardiographic data. , 1989, Journal of the American College of Cardiology.

[5]  J W Miller,et al.  The Dependence of Ultrasonic Attenuation and Backscatter on Collagen Content in Dog and Rabbit Hearts , 1980, Circulation research.

[6]  R. Macalpin,et al.  Left ventricular hypertrophy diagnosed by echocardiography. , 1973, The New England journal of medicine.

[7]  W. Roberts,et al.  Quantitative Analysis of Cardiac Muscle Cell Disorganization in the Ventricular Septum of Patients with Hypertrophic Cardiomyopathy , 1979, Circulation.

[8]  Sanford P. Bishop,et al.  Adaptations of the left ventricle to chronic pressure overload , 1976 .

[9]  W. Henry,et al.  Asymmetric Septal Hypertrophy (ASH): The Unifying Link in the IHSS Disease Spectrum Observations Regarding its Pathogenesis, Pathophysiology, and Course , 1973, Circulation.

[10]  L. Wann,et al.  Influence of heart rate, preload, afterload, and inotropic state on myocardial ultrasonic backscatter. , 1988, Circulation.

[11]  B. Maron,et al.  Relation between extent of left ventricular hypertrophy and diastolic filling abnormalities in hypertrophic cardiomyopathy. , 1990, Journal of the American College of Cardiology.

[12]  L S Wann,et al.  Intramyocardial variability in integrated backscatter: effects of coronary occlusion and reperfusion. , 1987, Circulation.

[13]  J. Strohbehn,et al.  Two-dimensional ultrasonic tissue characterization: backscatter power, endocardial wall motion, and their phase relationship for normal, ischemic, and infarcted myocardium. , 1987, Circulation.

[14]  J. G. Miller,et al.  Ultrasonic tissue characterization with integrated backscatter. Acute myocardial ischemia, reperfusion, and stunned myocardium in patients. , 1989, Circulation.

[15]  J. G. Miller,et al.  Regional differences in the cyclic variation of myocardial backscatter that parallel regional differences in contractile performance. , 1984, The Journal of the Acoustical Society of America.

[16]  B. Maron,et al.  Diastolic abnormalities in patients with hypertrophic cardiomyopathy: relation to magnitude of left ventricular hypertrophy. , 1985, Circulation.

[17]  L. Landini,et al.  Quantitative assessment of ultrasonic myocardial reflectivity in hypertrophic cardiomyopathy. , 1991, Journal of the American College of Cardiology.

[18]  D TEARE,et al.  ASYMMETRICAL HYPERTROPHY OF THE HEART IN YOUNG ADULTS , 1958, British heart journal.

[19]  R. Gramiak,et al.  Role of Echocardiography in Diagnostic and Hemodynamic Assessment of Hypertrophic Subaortic Stenosis , 1971, Circulation.

[20]  A. L. Brown,et al.  The Clinical, Hemodynamic, and Pathologic Diagnosis of Muscular Subvalvular Aortic Stenosis , 1961, Circulation.

[21]  I Schnittger,et al.  Serial measurement of integrated ultrasonic backscatter in human cardiac allografts for the recognition of acute rejection. , 1990, Circulation.

[22]  E Picano,et al.  In vivo quantitative ultrasonic evaluation of myocardial fibrosis in humans. , 1990, Circulation.

[23]  J. G. Miller,et al.  Quantitative ultrasonic tissue characterization with real-time integrated backscatter imaging in normal human subjects and in patients with dilated cardiomyopathy. , 1987, Circulation.

[24]  S. M. Collins,et al.  Quantitative texture analysis in two-dimensional echocardiography: application to the diagnosis of experimental myocardial contusion. , 1983, Circulation.

[25]  W. Roberts,et al.  Comparison of Echocardiographic and Necropsy Measurements of Ventricular Wall Thicknesses in Patients with and without Disproportionate Septal Thickening , 1977, Circulation.

[26]  W. Roberts,et al.  Intramural ("small vessel") coronary artery disease in hypertrophic cardiomyopathy. , 1986, Journal of the American College of Cardiology.

[27]  D. Skorton,et al.  Reproducibility of quantitative backscatter echocardiographic imaging in normal subjects. , 1992, The American journal of cardiology.

[28]  D. Harrison,et al.  Ultrasound in the Diagnosis and Evaluation of Therapy of Idiopathic Hypertrophic Subaortic Stenosis , 1969, Circulation.

[29]  D. Gibson,et al.  Clinical application of amplitude processing of echocardiographic images. , 1981, British heart journal.

[30]  Y. Hamashima,et al.  Classification and distribution of myocardial fascicle and fiber disarray in 14 hearts with hypertrophic cardiomyopathy in 25 mu thick sections. , 1982, Japanese circulation journal.

[31]  J. G. Miller,et al.  Relationship between collagen and ultrasonic backscatter in myocardial tissue. , 1981, The Journal of the Acoustical Society of America.

[32]  B. Maron,et al.  Hypertrophic cardiomyopathy. Recent observations regarding the specificity of three hallmarks of the disease: asymmetric septal hypertrophy, septal disorganization and systolic anterior motion of the anterior mitral leaflet. , 1980, The American journal of cardiology.

[33]  H. Badeer.  BIOLOGICAL SIGNIFICANCE OF CARDIAC HYPERTROPHY. , 1964, The American journal of cardiology.

[34]  L Landini,et al.  Normal Ultrasonic Myocardial Reflectivity in Athletes with Increased Left Ventricular Mass: A Tissue Characterization Study , 1992, Circulation.

[35]  B. Healy,et al.  Hypertensive hypertrophic cardiomyopathy or hypertrophic cardiomyopathy with hypertension? A study of 78 patients. , 1989, Journal of the American College of Cardiology.

[36]  S. M. Collins,et al.  Cyclic variation of ultrasound backscatter in normal myocardium is view dependent: clinical studies with a real-time backscatter imaging system. , 1989, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[37]  J. G. Miller,et al.  Ultrasonic characterization of myocardium. , 1985, Progress in cardiovascular diseases.

[38]  V. Ferrans,et al.  Myocardial Ultrastructure in Idiopathic Hypertrophic Subaortic Stenosis: A Study of Operatively Excised Left Ventricular Outflow Tract Muscle in 14 Patients , 1972, Circulation.

[39]  J. G. Miller,et al.  The dependence of myocardial ultrasonic integrated backscatter on contractile performance. , 1985, Circulation.

[40]  J. G. Miller,et al.  Ultrasound integrated backscatter tissue characterization of remote myocardial infarction in human subjects. , 1989, Journal of the American College of Cardiology.

[41]  A. DeMaria,et al.  Recommendations Regarding Quantitation in M-Mode Echocardiography: Results of a Survey of Echocardiographic Measurements , 1978, Circulation.

[42]  R. Popp,et al.  Ultrasonic tissue characterization of human hypertrophied hearts in vivo with cardiac cycle-dependent variation in integrated backscatter. , 1989, Circulation.

[43]  C Kawai,et al.  Quantitative analysis of myocardial fibrosis in normals, hypertensive hearts, and hypertrophic cardiomyopathy. , 1986, British heart journal.

[44]  W. Roberts,et al.  Quantitative Analysis of the Distribution of Cardiac Muscle Cell Disorganization in the Left Ventricular Wall of Patients with Hypertrophic Cardiomyopathy , 1981, Circulation.

[45]  J. G. Miller,et al.  Changes in myocardial backscatter throughout the cardiac cycle. , 1983, Ultrasonic imaging.

[46]  L. Landini,et al.  In vivo radiofrequency ultrasound analysis of normal human heart structures , 1987, Journal of clinical ultrasound : JCU.

[47]  J. G. Miller,et al.  Sensitive detection of the effects of reperfusion on myocardium by ultrasonic tissue characterization with integrated backscatter. , 1986, Circulation.

[48]  R L Popp,et al.  Influence of the orientation of myocardial fibers on echocardiographic images. , 1987, The American journal of cardiology.

[49]  J. G. Miller,et al.  A relationship between ultrasonic integrated backscatter and myocardial contractile function. , 1985, The Journal of clinical investigation.