Comparative Study of the Echocardiographic Findings in Hypertensive and Nonhypertensive Cardiomyopathy

Thirty adult male patients with advanced myocardial disease were evaluated by echocardiography. Fourteen were hypertensive; 16 were normotensive. In the former group, 7 subjects had hypertension alone; 7 had combined hypertension and alcoholism or ischemia. The latter group included 4 patients with ischemia, 6 patients with alcoholism, and 6 with idiopathic cardiomyopathy. Nine of the 14 hypertensives and 3 of 6 subjects with ischemic disease had diabetes. Compared to the normotensives, the hypertensive subjects had greater posterior wall thickness (10.4 ± 1.3 mm versus 8.3 ± 1.1 mm) (p <0.001), a larger left ventricular mass (expressed as cross-sectional area) (26.8 ± 6.6 cm² versus 19.6 ± 3.3 cm²) (p <0.001) and a larger aortic root dimension (34.9 ± 2.8 mm versus 30.3 ± 5.5 mm) (p <0.01). Aortic root size was >32 mm in 12 of 16 hypertensive and in only 3 of 16 without hypertension. Reduction in the percentage of systolic thickening of the septum was more pronounced than that of the posterior wall in all types of cardiomyopathy (1.30 ± 4.0% versus 24.6 ± 16.0%, respectively) (p <0.001) and excursion of interventricular septum and posterior wall was uniformly depressed. Ischemic heart disease could therefore not be differentiated from other forms of cardiomyopathy by analysis of segmental function. When cardiomyopathy was associated with mitral insufficiency, the posterior aortic root motion was greater (6.6 ± 1.7 mm) than in its absence (3.4 ± 1.0 mm) (p <0.001), and the septal excursion was more pronounced with mitral incompetance. Additional echocardiographic features of cardiomyopathy included the uniform presence of multiple systolic echoes and 'hammock' appearance of the mitral valve and the AC notching of the tricuspid valve. We conclude that hypertensive cardiomyopathy can be distinguished from nonhypertensive types of advanced heart disease but that ischemic, alcoholic, and idiopathic cardiomyopathies cannot be differentiated by echocardiography.