New Insights into Septal Anterior Wall Motion Velocities at End-Systole in Normal and Hypertrophied Left Ventricles

AIMS: It was two-fold (1) to define tissue Doppler echocardiographic characteristics of the end-systolic septal anterior motion: passive due to heart translation, or active motion free of translational effects, substantiated by a myocardial velocity gradient. (2) to specify the temporal features of this septal anterior motion on normal and hypertrophied left ventricles since it occurs while the posterior wall contracts during late ejection. METHODS AND RESULTS: Myocardial velocity gradient was calculated during the anterior motion in simultaneously colour M-mode imaged septal and posterior walls of 21 controls (49+/-12 years) and 17 patients (49+/-13 years) with left ventricle hypertrophy. Timings of septal motion were compared with flow and posterior wall motion. In controls, septal anterior motion started prior to, and overlapped the end of subaortic flow and that of the posterior wall anterior motion. Myocardial velocity gradient was found, exceeding that at the posterior wall (2.5+/-1.6 vs 0.9+/-0.5s(-1), P=0.001). In patients, septal myocardial velocity gradient was lower than in controls (1.2+/-1.04 s(-1)P=0.006). The anterior motion had a longer duration than in controls (75+/-37 vs 50+/-17ms, P=0.003). Myocardial velocity gradient and duration were correlated with septal thickness (P=<0.01). CONCLUSIONS: The septal anterior motion was active. Patients showed a decreased myocardial velocity gradient, while wall asynchrony increased. Unusual higher septal than posterior wall systolic velocities at tissue Doppler echocardiography may suggest a relaxation pattern, in spite of its end-systolic onset.