Clinical characteristics and outcomes of patients with hypertrophic cardiomyopathy with latent obstruction

Vaglio, Joseph C.; Ommen, Steve R.; Nishimura, Rick A.; Tajik, A. Jamil; Gersh, Bernard J.

doi:10.1016/j.ahj.2008.04.002

Cited by 57 publications

(52 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…1,2) While some HCM patients do not develop LVOTO at rest, it can be induced by stressors such as exercise or pharmacological stimulation, and has thus been termed latent LVOTO (L-LVOTO). 3) L-LVOTO can be even provoked in patients without HCM or significant left ventricular hypertrophy (non-LVH). 4,5) Although L-LVOTO in non-LVH patients has a potential to induce cardiovascular events, the prevalence, clinical course, and prognosis of L-LVOTO in non-LVH patients still remain elusive.…”

Section: Eft Ventricular Outflow Obstruction (Lvoto) Occurs Inmentioning

confidence: 99%

“…According to a previous study that evaluated the normal range of LVOT peak velocity and the criterion for L-LVO-TO in HCM patients, in this study we defined patients with an LVOT peak velocity ≥ 2.7 m/second during DSE as L-LVOTO (+). 3,10) The subjects were asked about symptoms such as chest pain, chest pressure, chest discomfort, dyspnea, and near syncope during the examination.…”

Section: Populationmentioning

confidence: 99%

See 1 more Smart Citation

Basic Echocardiographic Features of Patients With Latent Left Ventricular Outflow Tract Obstruction Without Left Ventricular Hypertrophy

et al. 2012

View full text Add to dashboard Cite

SummaryLeft ventricular outflow tract obstruction (LVOTO) is commonly observed in patients with hypertrophic cardiomyopathy (HCM) or left ventricular hypertrophy (LVH). While some patients develop LVOTO at rest, it can also be provoked by physical exertion, and hence termed latent LVOTO (L-LVOTO). Recent reports demonstrated that L-LVOTO develops not only in LVH patients, but also in patients without LVH (non-LVH). However, the prevalence and clinical prognosis of non-LVH patients with L-LVOTO are not yet elucidated. In this study, we retrospectively investigated the echocardiographic features of patients with malignancy who underwent dobutamine stress echocardiography (DSE) to evaluate preoperative cardiac risk. One hundred ninety-nine patients were found not to have LVH or coronary artery disease. Among them, 106 patients exhibited L-LVOTO after DSE. We next compared the baseline echocardiographic features of L-LVOTO (+) patients with those of L-LVOTO (-) patients, and identified the left ventricular outflow tract (LVOT) ratio (systolic LVOT diameter/diastolic LVOT diameter) as a significant predictor of L-LVOTO. An LVOT ratio ≤ 0.83 was the best cutoff value to detect the presence of L-LVOTO, with a sensitivity of 81.1% and specificity of 80.6%. Overall, L-LVOTO was found to develop in almost half of non-LVH patients with malignancy. In addition, the baseline LVOT ratio was strongly related to the presence of L-LVOTO in non-LVH patients. Therefore, patients with dynamic LVOT narrowing may benefit from DSE to detect the presence of L-LVOTO. (Int Heart J 2012; 53: 230-233) Key words: Latent left ventricular outflow tract obstruction, Dobutamine stress echocardiography L eft ventricular outflow obstruction (LVOTO) occurs in about 25% of patients with hypertrophic cardiomyopathy (HCM). 1,2) LVOTO in HCM causes cardiovascular events such as angina, syncope, and heart failure, and is associated with an adverse clinical prognosis.1,2) While some HCM patients do not develop LVOTO at rest, it can be induced by stressors such as exercise or pharmacological stimulation, and has thus been termed latent LVOTO (L-LVOTO).3) L-LVOTO can be even provoked in patients without HCM or significant left ventricular hypertrophy (non-LVH). 4,5) Although L-LVOTO in non-LVH patients has a potential to induce cardiovascular events, the prevalence, clinical course, and prognosis of L-LVOTO in non-LVH patients still remain elusive. Therefore, such patients have to be followed carefully and their clinical outcome characterized.While one useful modality for detecting L-LVOTO is dobutamine stress echocardiography (DSE), 6) it cannot be performed easily in all hospital settings. Accordingly, there is a need for identification of the basic echocardiographic features that suggest the presence of L-LVOTO in non-LVH patients.In this study, we retrospectively investigated the baseline echocardiographic characteristics of non-LVH patients, andshowed that the dynamics of the left ventricular outflow dimension are strongly related to the presence ...

show abstract

Section: Eft Ventricular Outflow Obstruction (Lvoto) Occurs Inmentioning

confidence: 99%

Section: Populationmentioning

confidence: 99%

Basic Echocardiographic Features of Patients With Latent Left Ventricular Outflow Tract Obstruction Without Left Ventricular Hypertrophy

et al. 2012

View full text Add to dashboard Cite

show abstract

“…The risk of progression to functional class III or IV NYHA and death by heart failure or stroke is greater in the non-obstructive forms, mainly after 40 years old 25 . The latent obstruction is also implied in the development of disabling symptoms and evolution to heart failure 27,34 .…”

Section: Clinical Picturementioning

confidence: 99%

O diagnóstico da obstrução da via de saída do ventrículo esquerdo na cardiomiopatia hipertrófica

Mattos¹,

Torres²,

Rebelatto³

et al. 2012

Arq. Bras. Cardiol.

View full text Add to dashboard Cite

Hypertrophic cardiomyopathy is a prevalent genetic disease characterized by left ventricular hypertrophy, presenting dynamic obstruction of outflow tract with subaortic gradient happening at rest in 30% of the cases. It is attributed to the intricate interaction between the anterior mitral leaflet, the interventricular septum and altered flow vectors generated in left ventricle along with changes in outflow tract geometry. Mitral regurgitation in varying degrees is found with or without association with structural deformities of the valve apparatus. The exercise echocardiogram evidences latent obstruction easily induced by exercise in 60 to 75% of nonobstructive forms. The determination of the gradient under this condition must be considered in routine investigation of patients with mild or no obstruction at rest. The evaluation of hypertrophic cardiomyopathy incorporates methods based on the ultrasound image, which, along with MRI, allow recognizing ventricular obstruction generating mechanisms, thus facilitating the diagnosis and management of obstructive and latent obstructive forms.

show abstract

“…However, there is recent debate regarding the optimal management for those patients exhibiting debilitating symptoms but with a minimal LVOT gradient. Indeed, a majority of these patients will have latent, or provocable, LVOT obstruction that can manifest after physical exertion, a Valsalva maneuver, isoproterenol infusion, or administration of amyl nitrite to gradients >50 mmHg (36,37). A recent study from Mayo Clinic compared outcomes after myectomy between those symptomatic patients with latent LVOT obstruction and those with high resting LVOT gradients.…”

mentioning

confidence: 99%

Surgical treatment for hypertrophic cardiomyopathy: a historical perspective

Hang¹,

Nguyen²,

Schaff³

2017

ASVIDE

View full text Add to dashboard Cite

Our understanding of hypertrophic cardiomyopathy (HCM) as a disease entity has increased dramatically over the last half century. There has been a concerted effort by several surgical groups to develop operative techniques to relieve left ventricular outflow tract (LVOT) obstruction and alleviate symptoms. This paper traces the development of transaortic septal myectomy, the current gold standard therapy for relief of LVOT obstruction, in symptomatic patients refractory to medical treatment. In addition, we introduce newer methods for myectomy that have expanded the role of surgery in patients with various forms of HCM.

show abstract

Clinical characteristics and outcomes of patients with hypertrophic cardiomyopathy with latent obstruction

Cited by 57 publications

References 20 publications

Basic Echocardiographic Features of Patients With Latent Left Ventricular Outflow Tract Obstruction Without Left Ventricular Hypertrophy

Basic Echocardiographic Features of Patients With Latent Left Ventricular Outflow Tract Obstruction Without Left Ventricular Hypertrophy

O diagnóstico da obstrução da via de saída do ventrículo esquerdo na cardiomiopatia hipertrófica

Surgical treatment for hypertrophic cardiomyopathy: a historical perspective

Contact Info

Product

Resources

About