Aim: To evaluate the commonly adopted ventriculographic and coronarographic criteria of hypertrophic cardiomyopathy.
Population: Eleven cases of obstructive cardiomyopathy, 14 non-obstructive cardiomyopathies, 15 discrete subaortic stenoses, 10 valvular aortic stenoses, and 12 cases of hypertensive heart disease. The diagnosis had been arrived at by independent clinical, electrocardiographic, echocardiographic and haemodynamic methods, as appropriate.
Methods: Retrospective "blind" examination of biplane left ventriculography (30 degrees right anterior oblique, 60 degrees left anterior oblique, with cranial tilt) and coronary arteriography. We looked for the following features: subaortic chamber, asymmetric septal hypertrophy, peculiar left ventricular shape and systolic obliteration, systolic anterior movement of the mitral leaflets, systolic narrowing or compression of epicardial coronary arteries and septal perforators.
Results and conclusions: The following left ventricular features were significantly more frequent in hypertrophic obstructive cardiomyopathy, than in other forms: subaortic chamber, "banana" configuration in systole, subaortic conus, asymmetric hypertrophy, systolic anterior movement of the anterior leaflet of the mitral valve, and mitral regurgitation. A subaortic chamber was seen both in the obstructive form and in the discrete subaortic stenosis, but the cranial left anterior oblique projection could easily discriminate between them. If non-obstructive cardiomyopathy is defined with the current criteria (provocable pressure gradient of < or = 30 mm Hg in a patient with left ventricular hypertrophy of no known cause), no distinctive angiographic features can distinguish it from other forms of secondary left ventricular hypertrophy.