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[Left ventricular outer wall motion in hypertrophic cardiomyopathy assessed by biplane coronary cineangiograms].

Left ventricular wall motion in patients with hypertrophic cardiomyopathy may show a characteristic movement since this condition is characterized by a disproportionate thickening of the wall and disorientation of myocardial muscle fibers. Biplane coronary cineangiograms were performed in 5 patients with hypertrophic cardiomyopathy and the spatial distance between the bifurcation of the left coronary artery was calculated using a digitizer-computer-plotter system as a measure of epicardial chord segment length. Systolic shortening of the segment was calculated as (LECG R--LES)/ECG R x 100 (%), where LECG R and LES represent segment lengths at the R wave of the electrocardiogram and at the end of systole, respectively. The value amounted 6.9 +/- 5.1 (+/- SD)% on the average which was significantly lower than the previously described values (9.0 +/- 4.1%) in 19 normal subjects. In all of 3 segments at the apex, systolic shortening showed nearly zero or negative indicating systolic expansion. Reduced shortening in patients with hypertrophic cardiomyopathy observed at the epicardial segment in the present study might be a reflection of geometrical difference between endocardial and epicardial segments because shortening of the epicardium will be reduced even the endocardium shortens considerably if the thickness of the wall is markedly increased. Anterior surface of the interventricular septum might be unable to shorten freely along the long axis since it is a junction of trifurcation among right and left ventricular free walls and the interventricular septum if these three walls are thickened. The present study indicated that shortening characteristics in the outer myocardium in patients with hypertrophic cardiomyopathy is markedly impaired possibly due to geometrical difference between endocardial and epicardial segments caused by marked thickening of the wall and also due to the degeneration or disorientation of myocardial fibers.