Document Detail


Hypertrophic cardiomyopathy is predominantly a disease of left ventricular outflow tract obstruction.
MedLine Citation:
PMID:  17088454     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Nonobstructive hypertrophic cardiomyopathy (HCM) has been regarded as the predominant hemodynamic form of the disease on the basis of assessment of outflow gradient under resting conditions. We sought to prospectively define the prevalence, clinical profile, and significance of left ventricular (LV) outflow tract obstruction under resting conditions and with physiological exercise in a large HCM cohort. METHODS AND RESULTS: We prospectively analyzed 320 consecutive HCM patients (age, 47+/-17 years), measuring LV outflow gradient at rest, with Valsalva maneuver, and with exercise echocardiography. LV outflow obstruction was present at rest and/or with exercise in 225 patients (70%); 119 had rest gradients > or = 50 mm Hg and were not exercised. Of the other 201 patients with gradients < 50 mm Hg at rest (average, 4+/-9 mm Hg), 106 developed mechanical obstruction to LV outflow resulting from mitral valve-septal contact after exercise (80+/-43 mm Hg), including 76 with marked gradients > or = 50 mm Hg and 46 with heart failure symptoms. The remaining 95 patients (30%) had no or small gradients (< 30 mm Hg) both at rest and with exercise. Valsalva maneuver underestimated the presence and magnitude of exercise-induced obstruction. CONCLUSIONS: Among those patients who come to clinical evaluation, HCM is a predominantly obstructive disease in which LV outflow gradients, frequently associated with heart failure symptoms and often identified only with exercise, are evident in most patients (ie, 70%). Identification of LV outflow obstruction with exercise echocardiography may broaden management options in HCM by identifying symptomatic patients not otherwise regarded as potential candidates for septal reduction therapy. Assessment of subaortic gradients with exercise should be a routine component of the evaluation of HCM patients without outflow obstruction under resting conditions.
Authors:
Martin S Maron; Iacopo Olivotto; Andrey G Zenovich; Mark S Link; Natesa G Pandian; Jeffery T Kuvin; Stefano Nistri; Franco Cecchi; James E Udelson; Barry J Maron
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Publication Detail:
Type:  Journal Article     Date:  2006-11-06
Journal Detail:
Title:  Circulation     Volume:  114     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2006 Nov 
Date Detail:
Created Date:  2006-11-22     Completed Date:  2006-12-14     Revised Date:  2007-07-03    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2232-9     Citation Subset:  AIM; IM    
Affiliation:
Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts-New England Medical Center, Boston, MA 02111, USA. mmaron@tufts-nemc.org
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged, 80 and over
Cardiac Output, Low / diagnosis,  etiology
Cardiomyopathy, Hypertrophic / complications*
Echocardiography, Stress
Female
Humans
Male
Middle Aged
Prevalence
Prospective Studies
Severity of Illness Index
Valsalva Maneuver
Ventricular Outflow Obstruction / diagnosis,  epidemiology*,  etiology,  physiopathology*
Comments/Corrections
Comment In:
Circulation. 2007 Jun 12;115(23):e622; author reply e623   [PMID:  17562964 ]
Circulation. 2006 Nov 21;114(21):2200-2   [PMID:  17116778 ]

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