Echocardiographic, haemodynamic, and angiographic correlations in hypertrophic cardiomyopathy.

Attempts to identify a pathognomonic abnormality in 'idiopathic hypertrophic subaortic stenosis' date back to the time of its recognition. We examined the echocardiographic, haemodynamic, and angiographic features of 14 consecutive patients in whom the clinical diagnosis was supported by the presence of both asymmetrical septal hypertrophy and systolic anterior movement of the anterior leaflet of the mnitral valve on the echocardiogram, or an intraventricular pressure gradient at rest or with provocation. A gradient was shown in 12 cases (86%), the Brockenbrough or postextrasystolic response in 9 (64%), asymmetrical septal hypertrophy in 11 (79%), systolic anterior movement in 7 (50%), and left ventricular cavity obliteration in systole in 12 (86%). Correlative analysis of these findings showed 8 of the patients with gradients lacking either asymmetrical septal hypertrophy (2) or systolic anterior movement (5), or both (1). All these had evidence of cavity obliteration. Two additional patients with cavity obliteration had both asynmnetrical septal hypertrophy and systolic anterior movement but no gradient, while 2 other patients with gradients showed no evidence of cavity obliteration. The Brockenbrough response was present in 3 patients without systolic anterior movement, one without asymmetrical septal hypertrophy, and one with neither, and was absent in one with both asymmetrical hypertrophy and systolic anterior movement. In conclusion, there appears to be no pathognomonic finding in this entity and what is usually diagnosed