| Delayed untwisting: the mechanistic link between dynamic obstruction and exercise tolerance in patients with hypertrophic obstructive cardiomyopathy. | |
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MedLine Citation:
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PMID: 19778676 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: We sought to determine the mechanisms linking dynamic obstruction and exercise tolerance in patients with hypertrophic obstructive cardiomyopathy (HOCM). BACKGROUND: Patients with HOCM have reduced exercise tolerance. However, the association between dynamic obstruction and peak oxygen consumption (VO2max) is weak. METHODS: We enrolled 25 patients with HOCM, 20 with hypertrophic cardiomyopathy (HCM), and 20 normal control patients. Two-dimensional, Doppler, strain, and left ventricular (LV) twist mechanics by speckle tracking echocardiography were obtained. The 25 HOCM patients had left heart catheterization, and 16 were re-examined after septal reduction. RESULTS: Deformation measurements were the lowest in HOCM patients and increased (p<0.05) after septal reduction. Twist and untwisting rate were not different between patients with HCM and control patients, but untwisting was significantly delayed in HCM patients and longest in HOCM patients. The delay related well with LV end-diastolic pressure (r=0.76) and volume (r=-0.73), and VO2max (r=-0.75, all p<0.01). After septal reduction, untwisting occurred earlier and accounted for the increase in end-diastolic volume (r=0.65), and VO2max (r=0.74, both p<0.05). CONCLUSIONS: Dynamic obstruction leads to delayed untwisting in HOCM, which accounts well for the increased LV filling pressures, the reduced LV volumes, and VO2max. After septal reduction, untwisting occurs earlier and leads to an improvement in LV filling and exercise tolerance. |
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Authors:
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Jianwen Wang; John M Buergler; Kumuthavally Veerasamy; Yelena P Ashton; Sherif F Nagueh |
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Publication Detail:
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Type: Controlled Clinical Trial; Journal Article |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 54 ISSN: 1558-3597 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 2009 Sep |
Date Detail:
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Created Date: 2009-09-25 Completed Date: 2009-11-10 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 1326-34 Citation Subset: AIM; IM |
Affiliation:
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Department of Cardiology, Methodist DeBakey Heart and Vascular Center, The Methodist Hospital, Houston, Texas 77030, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Cardiac Volume
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physiology Cardiomyopathy, Hypertrophic / physiopathology*, therapy* Diastole / physiology Echocardiography Ethanol / administration & dosage Exercise Tolerance / physiology* Female Heart Catheterization Heart Septum Humans Male Middle Aged Oxygen Consumption / physiology Torsion Abnormality / physiopathology, ultrasonography* |
| Chemical | |
Reg. No./Substance:
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64-17-5/Ethanol |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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