الفهرس 
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Abstract
Tissue Doppler Imaging (TDI) is a modification of conventional echo Doppler technology, being a substantial improvement of this modality, extending Doppler applications beyond the analysis of cardiac blood flows to the measurement of myocardial wall motion. Pulsed TDI is a relatively new index of myocardial function which might accurately detect minor changes in cardiac contractility otherwise undetectable by conventional echocardiography.
The aim of this work was to evaluate regional and global left ventricular function using tissue Doppler imaging (TDI) in pathological left ventricular hypertrophy resulting from hypertrophic cardiomyopathy and hypertension and to assess if there is any difference between both.
This study included 39 subjects:
HCM group: 14 patients with hypertrophic cardiomyopathy,
Hypertension group: 13 essential hypertension and LVH.
Control group: 12 normal subjects forming the control group.
All subjects were evaluated by history taking, clinical examination, and 12-lead ECG. Conventional echo was performed on all patients to assess left ventricular function and hypertrophy. Pulsed-wave TDI was performed on the mitral annulus, from the 4-chamber view for the medial and lateral sites
Each wall was divided into three segments, basal, mid and apical. While the apical long axis view visualized the posterior wall and was divided into basal and mid segments. The apical 4-chamber view represents both septal and lateral walls, the apical 2-chamber view represents anterior and inferior walls of the left ventricle and from the apical long axis the posterior segment were assessed PW-TDI tracings of the baseline myocardial velocities of the 9 segments (after excluding the apical segments) in addition to mitral annular velocity at the apical 4 chambers view was traced.
diastolic waves (e’ wave and a’ wave) with calculation of e’ /a’ ratio and the S wave ; which was presented as peak systolic velocity (PSV),and, The heterogeneity index of each parameter was calculated, which represents the physiological variation of the velocities at the four sites of the mitral annulus: basal septal, basal lateral ,basal anterior and basal inferior.
The following shows statistically significant differences between the HCM and hypertension groups:
1) Conventional echoDoppler
a: the LVEDD shows a mean value of 41 mm in HCM group and 49 mm in HTN group, LVESD shows mean value of 22.1mm in HCM and 30.9mm in HTN group , the LVPWT showed a mean value of 8.5mm in HCM and mean value of 11.8mm in HTN , statistically significant lower values in HCM group compared with HTN group.
b: the IVS showed a mean value of 19.8mm in HCM and 13.3 mm in HTN group and IVS/PWT ratio had mean value of 1.97 in HCM group and 1.04 in hypertension group, statistically significant higher values in HCM
2) Pulsed Tissue Doppler
a: The e’ wave velocities showed significant lower values in the basal anterior mean value of 4.55 cm/sec versus 6.55cm/sec in HTN group ,the posterior segment showed a mean of 4.8cm/sec in the HCM patients and 7.3cm/sec in HTN group
b: The a’ wave showed statistically significant lower velocities in the HCM group when compared to hypertension group in basal septum , 5.9 cm/sec versus 8.3cm/sec in HTN group, the basal inferior showed mean value of 6.4cm/sec Vs 8.3 cm/sec in HTN subjects
c: The S wave had significantly lower values at the posterior segment in the HCM patients with mean of 5.3cm/sec in HCM and 8.3cm/sec in HTN patients
d: The HI was significantly higher with a’ velocities with trend to be higher in S but not in the e’ wave, the HI of a’ velocity was 0.8 in HCM and 0.3 in hypertensive group.