Estimation of regional stress in the left ventricular septum and free wall: an echocardiographic study suggesting a mechanism for asymmetric septal hypertrophy.

Although asymmetric septal hypertrophy is noted in a wide variety of cardiac disorders, its cause remains unclear. One possible mechanism is that the septum is subjected to greater systolic stress because of its flatter (more eccentric) contour. This was investigated noninvasively in nine subjects by estimation of regional myocardial stress from measurements of blood pressure by cuff sphygmomanometry and by echocardiographic examinations of left ventricular shape and dimensions. Analysis of left ventricular cavity shape showed that both the free and septal walls were elliptical, but the septum was more eccentric than the free wall. Using a conceptual model to determine changes in regional systolic stress, the theoretical rate of increase in regional stress relative to pressure (delta S/delta P) was significantly greater in the septum compared to the free wall. Increased hypertrophy of the septum to normalize this increased delta S/delta P may be the cause of asymmetric septal hypertrophy in many disorders associated with elevated left ventricular pressure.