Unmasking Obstruction in Hypertrophic Cardiomyopathy With Postprandial Resting and Treadmill Stress Echocardiography.

Autor:	Massera D; Hypertrophic Cardiomyopathy Program, NYU Langone Health, New York, New York; Echocardiography Laboratory, Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York., Long C; Department of Medicine, NYU Langone Health, New York, New York., Xia Y; Division of Biostatistics, NYU Langone Health, New York, New York., James L; Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York., Adlestein E; Hypertrophic Cardiomyopathy Program, NYU Langone Health, New York, New York., Alvarez IC; Hypertrophic Cardiomyopathy Program, NYU Langone Health, New York, New York., Wu WY; Hypertrophic Cardiomyopathy Program, NYU Langone Health, New York, New York., Reuter MC; Hypertrophic Cardiomyopathy Program, NYU Langone Health, New York, New York., Arabadjian M; Center for Population and Health Services Research, Department of Foundations of Medicine, NYU Grossman Long Island School of Medicine, Mineola, New York., Grossi EA; Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York., Saric M; Echocardiography Laboratory, Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York., Sherrid MV; Hypertrophic Cardiomyopathy Program, NYU Langone Health, New York, New York; Echocardiography Laboratory, Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York. Electronic address: Mark.Sherrid@nyulangone.org.
Jazyk:	angličtina
Zdroj:	Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography [J Am Soc Echocardiogr] 2024 Oct; Vol. 37 (10), pp. 971-980. Date of Electronic Publication: 2024 Jun 29.
DOI:	10.1016/j.echo.2024.06.011
Abstrakt:	Background: Latent left ventricular outflow tract obstruction (LVOTO) is an important cause of symptoms in patients with hypertrophic cardiomyopathy (HCM) but can be challenging to provoke. Objectives and Methods: To examine the value of postprandial resting and stress echocardiography and utilization of invasive or enhanced drug therapies (surgical myectomy, alcohol septal ablation, disopyramide, and mavacamten) in patients with postprandial LVOTO. Consecutive HCM patients without LVOTO underwent routine and postprandial echocardiography at rest, with provocation (Valsalva and standing) and after symptom-limited treadmill stress. Results: Among 252 patients (mean age, 58 years, 39% women), postprandial LVOT gradients were higher compared with routine echocardiography at rest (median, 9.0 [0-38.0] vs 0 [0-14.0] mm Hg; P < .0001) and with provocation (18.5 [0-70.3] vs 1.5 [0-41.0] mm Hg; P < .0001). Postprandial exercise stress echocardiogram (PPXSE) gradients were higher in a subset of 44 patients who underwent both postprandial and fasting stress echocardiography (47.0 [5.3-81.0] vs 17.5 [0-46.0] mm Hg; P < .0001). In total, 49 (19.5%) patients achieved the ≥50 mm Hg threshold under routine conditions (rest/provocation); 90 (35.7%) additional patients achieved postprandial gradients ≥50 mm Hg (rest/provocation/exercise), 38 (15.1%) with PPXSE alone. A total of 71 patients were treated with 91 invasive or enhanced drug therapies, 32 (45.1%) of whom had gradients ≥50 mm Hg only after eating (rest/provocation) and 8 (11.3%) only with PPXSE, with symptom relief in the majority. Conclusions: Postprandial echocardiography was useful at unmasking LVOTO in more than one-third of patients who did not have high gradients otherwise. Eating before echocardiography is a powerful provocative tool in the evaluation of patients with HCM. Competing Interests: Conflicts of Interest D.M. reports consulting fees from Sanofi, Tenaya Therapeutics, and Chiesi; M.R. reports consulting fees from Bristol Myers Squibb; Mu.S reports consulting fees from Siemens and speaking fees from Abbott, Boston Scientific, Medtronic, and Philips; Ma.S. reports consulting fees from Pfizer and serving as consultant for Cytokinetics. All other authors declare that they have no conflicts of interest. (Copyright © 2024 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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