'Pseudo' systolic anterior motion in patients with hypertensive heart disease

The systolic motion of the mitral apparatus in patients withhypertensive heart disease and hypertrophic cardiomyopathy wasstudied in order to quantify the difference. Twelve out of 37patients with severe systemic hypertension were found to haveabnormal systolic anterior motion and had significantly smallerleft ventricular end-systolic dimension (P <0.05) and greaterejection fraction and mean velocity of circumferential fibreshortening (P <0.01 for each) than the other hypertensivepatients without abnormal systolic anterior motion. A comparisonbetween systolic anterior motion in 12 hypertensive patientsand mild or moderate systolic anterior motion in 28 patientswith hypertrophic cardiomyopathy showed a clear cut difference.‘Pseudo’ systolic anterior motion reached its peakat end-systole when the posterior wall had contracted fully.‘True’ systolic anterior motion, however, reachedits peak much earlier than maximum movement of the posteriorwall—approximately after two-thirds of systole had beencompleted. At the time of mitral valve opening, ‘pseudo’systolic anterior motion had not yet returned to this initiallevel, whereas ‘true’ systolic anterior motion returnedprior to the opening of the mitral valve. Anterior chordal motionin hyperdynamic ventricle appears to play a role in the productionof ‘pseudo’ systolic anterior motion.