Document Detail

Diagnostic value of left ventricular outflow area in patients with hypertrophic cardiomyopathy: a real-time three-dimensional echocardiographic study.
MedLine Citation:
PMID:  18325733     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Earlier studies demonstrated the ability of real-time 3-dimensional (3D) echocardiography (3DE) to measure left ventricular outflow tract (LVOT) area (A(LVOT)) in patients with hypertrophic cardiomyopathy (HCM). However, its clinical value is unknown. OBJECTIVE: We sought to investigate the feasibility and accuracy of real-time 3DE-derived A(LVOT) to diagnose significant LVOT obstruction in a large number of patients with HCM. METHODS: A total of 162 patients with HCM had 3DE by using a volumetric system. The smallest A(LVOT) during systole was determined by moving a 2-dimensional plane in 3D space. The pressure gradient across LVOT was assessed by continuous wave Doppler method. Provocation was performed in patients without significant LVOT obstruction (pressure gradient across LVOT < 50 mm Hg) at rest. RESULTS: Twenty (12%) patients with poor image quality of 3DE were excluded; 16 (28%) patients with a volumetric system, but only 4 (4%) patients with commercial equipment (P < .001). In the remaining 142 patients, A(LVOT) inversely correlated with pressure gradient across LVOT both at rest (r = 0.82, P < .001) and after provocation (r = 0.60, P < .001). The value of A(LVOT) less than 0.85 cm(2) and less than 2.0 cm(2) predicted resting and provokable LVOT obstruction with sensitivity of 87% and 81%, and specificity of 77% and 90%, respectively. CONCLUSIONS: Real-time 3DE measurement of A(LVOT) was successful in diagnosing and quantifying LVOT obstruction at rest and after provocation in a large number of patients with HCM.
Shota Fukuda; Harry M Lever; William J Stewart; Hung Tran; Jong-Min Song; Mi-Seong Shin; Neil L Greenberg; Nozomi Wada; Yoshiki Matsumura; Manatomo Toyono; Nicholas G Smedira; James D Thomas; Takahiro Shiota
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2008-03-06
Journal Detail:
Title:  Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography     Volume:  21     ISSN:  1097-6795     ISO Abbreviation:  J Am Soc Echocardiogr     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-07-01     Completed Date:  2008-08-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8801388     Medline TA:  J Am Soc Echocardiogr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  789-95     Citation Subset:  IM    
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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MeSH Terms
Blood Flow Velocity / physiology
Cardiomyopathy, Hypertrophic / complications,  physiopathology,  ultrasonography*
Diagnosis, Differential
Echocardiography, Three-Dimensional / methods*
Feasibility Studies
Heart Ventricles / physiopathology,  ultrasonography*
Middle Aged
Reproducibility of Results
Severity of Illness Index
Time Factors
Ventricular Function, Left / physiology*
Ventricular Outflow Obstruction / etiology,  physiopathology,  ultrasonography*
Ventricular Pressure / physiology

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