Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1981 Feb;45(2):206–212. doi: 10.1136/hrt.45.2.206

Specificity of systolic anterior motion of anterior mitral leaflet for hypertrophic cardiomyopathy. Prevalence in large population of patients with other cardiac diseases.

B J Maron, J S Gottdiener, L W Perry
PMCID: PMC482511  PMID: 7193042

Abstract

The value of systolic anterior motion of the anterior mitral leaflet as a diagnostic marker for hypertrophic cardiomyopathy has been questioned because of its reported occurrence in other heart diseases. To determine the true specificity of systolic anterior motion for hypertrophic cardiomyopathy, 721 echocardiograms from patients with a wide variety of cardiac diseases were reviewed for its presence or absence under basal conditions. Systolic anterior motion of the anterior mitral leaflet was present in only 22 (3.0%) of the 721 patients, giving a specificity of 97 per cent. It was most common in patients with d-transposition of the great vessels (11 of 51, or 21%). With patients having transposition of the great vessels excluded from the analysis, the prevalence of systolic anterior motion of the anterior mitral leaflet was only 1.6 per cent (specificity 98%). Of note, eight of the 11 patients with systolic anterior motion of the anterior mitral leaflet and diseases other than transposition of the great vessels had disproportionate thickening of the ventricular septum, making it exceedingly rare in a patient population with normal septal-free wall thickness ratios (prevalence 0.4%; specificity 99%). Hence, while systolic anterior motion is not pathognomonic of hypertrophic cardiomyopathy, it was an uncommon finding in a large population of patients with a variety of cardiac diseases; when present in such patients systolic anterior motion of the anterior mitral leaflet is usually associated with disproportionate septal thickening.

Full text

PDF
206

Images in this article

209Image
on p.209

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aziz K. U., Paul M. H., Idriss F. S., Wilson A. D., Muster A. J. Clinical manifestations of dynamic left ventricular outflow tract stenosis in infants with d-transposition of the great arteries with intact ventricular septum. Am J Cardiol. 1979 Aug;44(2):290–297. doi: 10.1016/0002-9149(79)90319-9. [DOI] [PubMed] [Google Scholar]
  2. Aziz K. U., Paul M. H., Muster A. J. Echocardiographic assessment of left ventricular outflow tract in d-transposition of the great arteries. Am J Cardiol. 1978 Mar;41(3):543–551. doi: 10.1016/0002-9149(78)90013-9. [DOI] [PubMed] [Google Scholar]
  3. Aziz K. U., Paul M. H., Muster A. J. Echocardiographic localization of interatrial baffle after Mustard operation for dextrotransposition of the great arteries. Am J Cardiol. 1976 Jul;38(1):67–72. doi: 10.1016/0002-9149(76)90064-3. [DOI] [PubMed] [Google Scholar]
  4. Bulkley B. H., Fortuin N. J. Systolic anterior motion of the mitral valve without asymmetric septal hypertrophy. Chest. 1976 May;69(5):694–696. doi: 10.1378/chest.69.5.694. [DOI] [PubMed] [Google Scholar]
  5. Bulkley B. H. Idiopathic hypertrophic subaortic stenosis afflicted: idols of the cave and the marketplace. Am J Cardiol. 1977 Sep;40(3):476–479. doi: 10.1016/0002-9149(77)90176-x. [DOI] [PubMed] [Google Scholar]
  6. Clark C. E., Henry W. L., Epstein S. E. Familial prevalence and genetic transmission of idiopathic hypertrophic subaortic stenosis. N Engl J Med. 1973 Oct 4;289(14):709–714. doi: 10.1056/NEJM197310042891402. [DOI] [PubMed] [Google Scholar]
  7. Davis R. H., Feigenbaum H., Chang S., Konecke L. L., Dillon J. C. Echocardiographic manifestations of discrete subaortic stenosis. Am J Cardiol. 1974 Feb;33(2):277–280. doi: 10.1016/0002-9149(74)90289-6. [DOI] [PubMed] [Google Scholar]
  8. Feizi O., Emanuel R. Echocardiographic spectrum of hypertrophic cardiomyopathy. Br Heart J. 1975 Dec;37(12):1286–1302. doi: 10.1136/hrt.37.12.1286. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Ferrans V. J., Morrow A. G., Roberts W. C. Myocardial ultrastructure in idiopathic hypertrophic subaortic stenosis. A study of operatively excised left ventricular outflow tract muscle in 14 patients. Circulation. 1972 Apr;45(4):769–792. doi: 10.1161/01.cir.45.4.769. [DOI] [PubMed] [Google Scholar]
  10. Gattiker H. F., Davignon A., Bozio A., Batlle-Diaz J., Geoffroy G., Lemieux B., Barbeau A. Echocardiographic findings in Friedreich's ataxia. Can J Neurol Sci. 1976 Nov;3(4):329–332. doi: 10.1017/s0317167100025543. [DOI] [PubMed] [Google Scholar]
  11. Gutgesell H. P., Mullins C. E., Gillette P. C., Speer M., Rudolph A. J., McNamara D. G. Transient hypertrophic subaortic stenosis in infants of diabetic mothers. J Pediatr. 1976 Jul;89(1):120–125. doi: 10.1016/s0022-3476(76)80945-6. [DOI] [PubMed] [Google Scholar]
  12. Gutgesell H. P., Speer M. E., Rosenberg H. S. Characterization of the cardiomyopathy in infants of diabetic mothers. Circulation. 1980 Feb;61(2):441–450. doi: 10.1161/01.cir.61.2.441. [DOI] [PubMed] [Google Scholar]
  13. Henry W. L., Clark C. E., Glancy D. L., Epstein S. E. Echocardiographic measurement of the left ventricular outflow gradient in idiopathic hypertrophic subaortic stenosis. N Engl J Med. 1973 May 10;288(19):989–993. doi: 10.1056/NEJM197305102881903. [DOI] [PubMed] [Google Scholar]
  14. Henry W. L., Clark C. E., Griffith J. M., Epstein S. E. Mechanism of left ventricular outlfow obstruction in patients with obstructive asymmetric septal hypertrophy (idiopathic hypertrophic subaortic stenosis). Am J Cardiol. 1975 Mar;35(3):337–345. doi: 10.1016/0002-9149(75)90025-9. [DOI] [PubMed] [Google Scholar]
  15. Maron B. J., Clark C. E., Henry W. L., Fukuda T., Edwards J. E., Mathews E. C., Jr, Redwood D. R., Epstein S. E. Prevalence and characteristics of disproportionate ventricular septal thickening in patients with acquired or congenital heart diseases: echocardiographic and morphologic findings. Circulation. 1977 Mar;55(3):489–496. doi: 10.1161/01.cir.55.3.489. [DOI] [PubMed] [Google Scholar]
  16. Maron B. J., Gottdiener J. S., Roberts W. C., Hammer W. J., Epstein S. E. Nongenetically transmitted disproportionate ventricular septal thickening associated with left ventricular outflow obstruction. Br Heart J. 1979 Mar;41(3):345–349. doi: 10.1136/hrt.41.3.345. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Maron B. J., Redwood D. R., Roberts W. C., Henry W. L., Morrow A. G., Epstein S. E. Tunnel subaortic stenosis: left ventricular outflow tract obstruction produced by fibromuscular tubular narrowing. Circulation. 1976 Sep;54(3):404–416. doi: 10.1161/01.cir.54.3.404. [DOI] [PubMed] [Google Scholar]
  18. Maron B. J., Roberts W. C. Quantitative analysis of cardiac muscle cell disorganization in the ventricular septum of patients with hypertrophic cardiomyopathy. Circulation. 1979 Apr;59(4):689–706. doi: 10.1161/01.cir.59.4.689. [DOI] [PubMed] [Google Scholar]
  19. Maron B. J., Savage D. D., Clark C. E., Henry W. L., Vlodaver Z., Edwards J. E., Epstein S. E. Prevalence and characteristics of disproportionate ventricular septal thickening in patients with coronary artery disease. Circulation. 1978 Feb;57(2):250–256. doi: 10.1161/01.cir.57.2.250. [DOI] [PubMed] [Google Scholar]
  20. Mintz G. S., Kotler M. N., Segal B. L., Parry W. R. Systolic anterior motion of the mitral valve in the absence of asymmetric septal hypertrophy. Circulation. 1978 Feb;57(2):256–263. doi: 10.1161/01.cir.57.2.256. [DOI] [PubMed] [Google Scholar]
  21. Nanda N. C., Gramiak R., Manning J. A., Lipchik E. O. Echocardiographic features of subpulmonic obstruction in dextro-transposition of the great vessels. Circulation. 1975 Mar;51(3):515–521. doi: 10.1161/01.cir.51.3.515. [DOI] [PubMed] [Google Scholar]
  22. Park S. C., Neches W. H., Zuberbuhler J. R., Mathews R. A., Lenox C. C., Fricker F. J. Echocardiographic and hemodynamic correlation in transposition of the great arteries. Circulation. 1978 Feb;57(2):291–298. doi: 10.1161/01.cir.57.2.291. [DOI] [PubMed] [Google Scholar]
  23. Popp R. L., Brown O. R., Silverman J. F., Harrison D. C. Echocardiographic abnormalities in the mitral valve prolapse syndrome. Circulation. 1974 Mar;49(3):428–433. doi: 10.1161/01.cir.49.3.428. [DOI] [PubMed] [Google Scholar]
  24. Popp R. L., Harrison D. C. Ultrasound in the diagnosis and evaluation of therapy of idiopathic hypertrophic subaortic stenosis. Circulation. 1969 Dec;40(6):905–914. doi: 10.1161/01.cir.40.6.905. [DOI] [PubMed] [Google Scholar]
  25. Pridie R. B., Oakley C. M. Mechanism of mitral regurgitation in hypertrophic obstructive cardiomyopathy. Br Heart J. 1970 Mar;32(2):203–208. doi: 10.1136/hrt.32.2.203. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Rees A., Elbl F., Minhas K., Solinger R. Echocardiographic evidence of outflow tract obstruction in Pompe's disease (glycogen storage disease of the heart). Am J Cardiol. 1976 Jun;37(7):1103–1106. doi: 10.1016/0002-9149(76)90433-1. [DOI] [PubMed] [Google Scholar]
  27. Rodger J. C. Motion of mitral apparatus in hypertrophic cardiomyopathy with obstruction. Br Heart J. 1976 Jul;38(7):732–737. doi: 10.1136/hrt.38.7.732. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Rossen R. M., Goodman D. J., Ingham R. E., Popp R. L. Echocardiographic criteria in the diagnosis of idiopathic hypertrophic subaortic stenosis. Circulation. 1974 Oct;50(4):747–751. doi: 10.1161/01.cir.50.4.747. [DOI] [PubMed] [Google Scholar]
  29. Sahn D. J., Terry R., O'Rourke R., Leopold G., Friedman W. F. Multiple crystal cross-sectional echocardiography in the diagnosis of cyanotic congenital heart disease. Circulation. 1974 Aug;50(2):230–238. doi: 10.1161/01.cir.50.2.230. [DOI] [PubMed] [Google Scholar]
  30. Savage D. D., Drayer J. I., Henry W. L., Mathews E. C., Jr, Ware J. H., Gardin J. M., Cohen E. R., Epstein S. E., Laragh J. H. Echocardiographic assessment of cardiac anatomy and function in hypertensive subjects. Circulation. 1979 Apr;59(4):623–632. doi: 10.1161/01.cir.59.4.623. [DOI] [PubMed] [Google Scholar]
  31. Scovil J. A., Nanda N. C., Gross C. M., Lombardi A. C., Gramiak R., Lipchick E. O., Manning J. A. Echocardiographic studies of abnormalities associated with coarctation of the aorta. Circulation. 1976 Jun;53(6):953–956. doi: 10.1161/01.cir.53.6.953. [DOI] [PubMed] [Google Scholar]
  32. Shah P. M., Gramiak R., Adelman A. G., Wigle E. D. Echocardiographic assessment of the effects of surgery and propranolol on the dynamics of outflow obstruction in hypertrophic subaortic stenosis. Circulation. 1972 Mar;45(3):516–521. doi: 10.1161/01.cir.45.3.516. [DOI] [PubMed] [Google Scholar]
  33. Shah P. M., Gramiak R., Adelman A. G., Wigle E. D. Role of echocardiography in diagnostic and hemodynamic assessment of hypertrophic subaortic stenosis. Circulation. 1971 Nov;44(5):891–898. doi: 10.1161/01.cir.44.5.891. [DOI] [PubMed] [Google Scholar]
  34. Shah P. M., Gramiak R., Kramer D. H. Ultrasound localization of left ventricular outflow obstruction in hypertrophic obstructive cardiomyopathy. Circulation. 1969 Jul;40(1):3–11. doi: 10.1161/01.cir.40.1.3. [DOI] [PubMed] [Google Scholar]
  35. Silverman N. H., Payot M., Stanger P., Rudolph A. M. The echocardiographic profile of patients after Mustard's operation. Circulation. 1978 Dec;58(6):1083–1093. doi: 10.1161/01.cir.58.6.1083. [DOI] [PubMed] [Google Scholar]
  36. Stern A., Kessler K. M., Hammer W. J., Kreulen T. H., Spann J. F. Septal-free wall disproportion in inferior infarction: the echocardiographic differentiation from hypertrophic cardiomyopathy. Circulation. 1978 Oct;58(4):700–706. doi: 10.1161/01.cir.58.4.700. [DOI] [PubMed] [Google Scholar]
  37. TEARE D. Asymmetrical hypertrophy of the heart in young adults. Br Heart J. 1958 Jan;20(1):1–8. doi: 10.1136/hrt.20.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Thompson R., Ahmed M., Pridie R., Yacoub M. Hypertrophic cardiomyopathy after aortic valve replacement. Am J Cardiol. 1980 Jan;45(1):33–41. doi: 10.1016/0002-9149(80)90216-7. [DOI] [PubMed] [Google Scholar]
  39. Toshima H., Koga Y., Yoshioka H., Akiyoshi T., Kimura N. Echocardiographic classification of hypertensive heart disease. A correlative study with clinical features. Jpn Heart J. 1975 Jul;16(4):377–393. doi: 10.1536/ihj.16.377. [DOI] [PubMed] [Google Scholar]
  40. Way G. L., Wolfe R. R., Eshaghpour E., Bender R. L., Jaffe R. B., Ruttenberg H. D. The natural history of hypertrophic cardiomyopathy in infants of diabetic mothers. J Pediatr. 1979 Dec;95(6):1020–1025. doi: 10.1016/s0022-3476(79)80302-9. [DOI] [PubMed] [Google Scholar]
  41. Weiss A. N., Mimbs J. W., Ludbrook P. A., Sobel B. E. Echocardiographic detection of mitral valve prolapse. Exclusion of false positive diagnosis and determination of inheritance. Circulation. 1975 Dec;52(6):1091–1096. doi: 10.1161/01.cir.52.6.1091. [DOI] [PubMed] [Google Scholar]
  42. van Dorp W. G., ten Cate F. J., Vletter W. B., Dohmen H., Roelandt J. Familial prevalence of asymmetric septal hypertrophy. Eur J Cardiol. 1976 Sep;4(3):349–357. [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES