Document Detail

Prevalence of exercise-induced left ventricular outflow tract obstruction in symptomatic patients with non-obstructive hypertrophic cardiomyopathy.
MedLine Citation:
PMID:  18032461     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Resting left ventricular outflow tract obstruction (LVOTO) occurs in 25% of patients with hypertrophic cardiomyopathy (HCM) and is an important cause of symptoms and disease progression. The prevalence and clinical significance of exercise induced LVOTO in patients with symptomatic non-obstructive HCM is uncertain. METHODS AND RESULTS: 87 symptomatic patients (43.3 (13.7) years, 67.8% males) with HCM and no previously documented LVOTO (defined as a gradient >or=30 mm Hg) underwent echocardiography during upright cardiopulmonary exercise testing: 54 patients (62.1%; 95% CI 51.5 to 71.6) developed LVOTO during exercise (latent LVOTO); 33 (37.9%; 95% CI 28.4 to 48.5) had neither resting nor exercise LVOTO (non-obstructive). Patients with latent LVOTO were more likely to have systolic anterior motion of the mitral valve (SAM) at rest (relative risk 2.1, 95% CI 1.2 to 3.8; p = 0.01), and higher peak oxygen consumption (mean difference: 10.3%, 95% CI 2.1 to 18.5; p = 0.02) than patients with non-obstructive HCM. The only independent predictors of Delta gradient during exercise were a history of presyncope/syncope, incomplete/complete SAM at rest and Wigle score (all p<0.05). Subsequent invasive reduction of LVOTO in 10 patients with latent obstruction and drug refractory symptoms resulted in improved functional class and less syncope/presyncope (all p<0.05). CONCLUSIONS: Approximately two-thirds of patients with symptomatic non-obstructive HCM have latent LVOTO. This study suggests that all patients with symptomatic non-obstructive HCM should have exercise stress echocardiography.
J S Shah; M T T Esteban; R Thaman; R Sharma; B Mist; A Pantazis; D Ward; S K Kohli; S P Page; C Demetrescu; E Sevdalis; A Keren; D Pellerin; W J McKenna; P M Elliott
Publication Detail:
Type:  Journal Article     Date:  2007-11-21
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  94     ISSN:  1468-201X     ISO Abbreviation:  Heart     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-09-19     Completed Date:  2008-10-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  England    
Other Details:
Languages:  eng     Pagination:  1288-94     Citation Subset:  AIM; IM    
The Heart Hospital, University College London, UK.
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MeSH Terms
Cardiomyopathy, Hypertrophic / etiology*,  physiopathology
Exercise / physiology*
Exercise Test
Follow-Up Studies
Middle Aged
Ventricular Outflow Obstruction / etiology*,  physiopathology
Comment In:
Heart. 2008 Oct;94(10):1249-50   [PMID:  18801784 ]

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