Hypertrophic Cardiomyopathy Is Predominantly a Disease of Left Ventricular Outflow Tract Obstruction
| Autor: | Jeffery T. Kuvin, Mark S. Link, Iacopo Olivotto, Andrey G. Zenovich, Stefano Nistri, James E. Udelson, Natesa G. Pandian, Franco Cecchi, Barry J. Maron, Martin S. Maron |
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| Rok vydání: | 2006 |
| Předmět: |
Adult
Male Alcohol septal ablation medicine.medical_specialty Valsalva Maneuver medicine.medical_treatment Cardiac Output Low Cardiomyopathy Ventricular outflow tract obstruction Ventricular Outflow Obstruction Severity of Illness Index Physiology (medical) Internal medicine Prevalence medicine Valsalva maneuver Humans Prospective Studies Aged 80 and over business.industry Hypertrophic cardiomyopathy Cardiomyopathy Hypertrophic Middle Aged medicine.disease Septal myectomy Heart failure cardiovascular system Cardiology Female medicine.symptom Cardiology and Cardiovascular Medicine business Echocardiography Stress |
| Zdroj: | Circulation. 114:2232-2239 |
| ISSN: | 1524-4539 0009-7322 |
| Popis: | 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 ≥50 mm Hg and were not exercised. Of the other 201 patients with gradients 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. |
| Databáze: | OpenAIRE |
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