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Aortic regurgitation in hypertrophic cardiomyopathy.

Aortic regurgitation (AR) has been sparsely reported in Hypertrophic Cardiomyopathy (HCM) but neither its frequency nor severity has been determined. 30 patients of HCM were evaluated both by Echocardiography as well as by Cardiac Catheterisation and angiography over a 2 year period. Most of them had echocardiographically normal aortic cusps. Patients were divided into 2 groups, those with AR (Group-I) and those without AR (Group-II). Group-I patients (10 patients) were significantly older than group-II (51 +/- 4 years vs 38 +/- 3 years, p < 0.001) and had larger end-diastolic dimension (EDD) (5 +/- 0.5 vs 2.5 +/- 0.4 cms p < 0.001) and end-systolic dimension (ESD) (3.2 +/- 0.3 vs 2.7 +/- 0.4 cms p < 0.05) of Left ventricle (LV) in Echo. LC Wall thickness, and LV asymmetric septal hypertrophy (ASH) and fractional shortening (FS) were similar in the 2 groups. Mitral regurgitation (MR) was more common in Group-I (100% vs 45% p < 0.001) although there was no difference in left atrial (LA) size between the two groups. The HCM patients were compared with a control group of 20 normal subjects. None of them (Normal) had any AR murmur or Doppler or angiography proved AR. Thus nearly 1/3rd of patients with HCM had mild AR by Doppler or aortic root angio and about 10% of HCM patients also had aortic early diastolic murmur. The AR most probably results from high velocity systolic blood flow causing microscopic or macroscopic damage to the valve cusps.