Basal septal hypertrophy

Abstract

A significant clinical problem is patients presenting with exercise-limiting dyspnoea, sometimes with associated chest pain, in the absence of detectable left ventricular (LV) systolic dysfunction, coronary artery disease, or lung disease. Often the patients are older, female, and have isolated basal septal hypertrophy (BSH), frequently on a background of mild hypertension. The topic of breathlessness in patients with clinical heart failure, but who have a normal ejection fraction (HFNEF) has attracted significant controversy over the past few years. This review aims to analyse the literature on BSH, identify the possible associations between BSH and HFNEF, and consequently explore possible pathophysiological mechanisms whereby clinical symptoms are experienced.

Fig. (1)

Comparison of normal myocardium, BSH, HCM, and concentric LVH on conventional two-dimensional echocardiography. PLAX = parasternal long axis view, SAX = short axis view, A4CH = apical 4-chamber view, A3CH= apical 3-chamber view.

Fig. (2)

Non-uniformity of the LV (longitudinal) curvature. R_apex: radius of curvature at the apex; R_lateral: radius of curvature at the lateral wall; R_septal : radius of curvature of the septum; PRV: pressure in the right ventricle. Taken from Baltabaeva et al. [13].

Fig. (3)

Graph showing association of LVEDV and Pulmonary capillary wedge pressure (LV filling pressure) in normal controls (closed box) and patients with HFNEF (open box). Used with permission from Kitzman et al. [25].