Document Detail

Standing and exercise Doppler echocardiography in obstructive hypertrophic cardiomyopathy: the range of gradients with upright activity.
MedLine Citation:
PMID:  21126858     Owner:  NLM     Status:  In-Data-Review    
BACKGROUND: The ideal provocative maneuver in patients with hypertrophic cardiomyopathy (HCM) is a subject of ongoing investigation. Standing is a fundamental activity of daily life. This study examined acquisition of standing, Valsalva, and post-exercise left ventricular outflow tract gradients in HCM.
METHODS: Rest supine, standing, and post-Valsalva gradients were measured in 98 consecutive patients with HCM who were referred for outpatient echocardiography. In 53 (54%) of the 98 patients, symptom-limited treadmill exercise was also performed, with gradients measured immediately after in the supine position.
RESULTS: Fifty-six (57%) of the 98 patients had resting gradient < 30 mm Hg and would thus be characterized as nonobstructive at rest. In the 98 patients, median gradients were 25 mm Hg at rest (range 0-205 mm Hg), increasing to 44 mm Hg after standing (range 0-309 mm Hg), an increase of 76%, and were again higher after Valsalva, 64 mm Hg (range 0-256 mm Hg) (P < .001). In the 53 patients who had gradient assessed after exercise, they were higher still, 100 mm Hg (range 0-256 mm Hg) (P < .001). In 29 patients (30%), standing provoked a higher gradient than Valsalva.
CONCLUSION: Although standing increased gradients by 76%, it is not as potent a provocative maneuver as Valsalva or treadmill exercise. Nevertheless, standing is recommended as a physiologic provocative maneuver. In some patients standing may guide therapy; in others, the standing and exercise gradient provide a correct appreciation of the range of physiologically experienced gradients during daily upright activity.
Sandeep Joshi; Utpal K Patel; Siu-Sun Yao; Vilma Castenada; April Isambert; Glenda Winson; Farooq A Chaudhry; Mark V Sherrid
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Publication Detail:
Type:  Journal Article     Date:  2010-12-03
Journal Detail:
Title:  Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography     Volume:  24     ISSN:  1097-6795     ISO Abbreviation:  J Am Soc Echocardiogr     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8801388     Medline TA:  J Am Soc Echocardiogr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  75-82     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.
St. Luke's-Roosevelt Hospital Center, Columbia University, College of Physicians and Surgeons, New York, New York.
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