Phenotyping Left Ventricular Obstruction With Postprandial Re-Test Echocardiography in Hypertrophic Cardiomyopathy

Canna, Giovanni La; Scarfò, Iside; Arendar, Iryna; Alati, E; Caso, Ilaria; Alfieri, Ottavio

doi:10.1016/j.amjcard.2020.03.004

Cited by 15 publications

(11 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One study demonstrated that a postprandial echocardiogram elicits a transient LVOT gradient more effectively than post-exercise or post-Valsalva studies. 3 In both of these cases, careful history taking and obtaining the correct image with the patient in the correct hemodynamic state were the essential steps in securing the diagnosis of HCM. In conclusion, obstructive HCM should also be included in the differential diagnosis of patients with dyspnea or syncope after meals, and a postprandial echocardiogram should be considered part of the workup in these cases.…”

Section: Discussionmentioning

confidence: 99%

2 Cases of Elusive Left Ventricular Outflow Tract Gradient

et al. 2022

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

2 Cases of Elusive Left Ventricular Outflow Tract Gradient

et al. 2022

View full text Add to dashboard Cite

“…Particular attention was paid to optimize alignment with left ventricular outflow tract flow for accurate IVG measurement, avoiding mistaken estimation based on the concomitant mitral regurgitant jet sample. As previously described [ 17 ], the LV obstruction mechanism is classified as SAM-related when it is due to septal contact of systolic anterior motion of mitral valve (SAM), non-SAM related when it is due to mid-cavity septal contact of papillary muscle, abnormal papillary insertion in the LVOT or apical obstruction, or combined (SAM-related and non-SAM-related). Concomitant SAM related mitral regurgitation was graded using vena contracta measurement with a diameter >7 mm as cut-off severity.…”

Section: Methodsmentioning

confidence: 99%

“…Following at-rest evaluation, the patients underwent TTE during Valsalva maneuver. In patients without significant IVG, a semisupine cycloergometer exercise test with 10 watt/min load incrementation every minute and a rest retest postprandial echocardiography were carried out to assess LV obstruction inducibility [ 17 ].…”

Section: Methodsmentioning

confidence: 99%

Targeting Alcohol Septal Ablation in Patients with Obstructive Hypertrophic Cardiomyopathy Candidates for Surgical Myectomy: Added Value of Three-Dimensional Intracoronary Myocardial Contrast Echocardiography

Canna

Scarfò

Arendar

et al. 2021

JCM

Self Cite

View full text Add to dashboard Cite

Background: Myocardial contrast two-dimensional echocardiography (MC-2DE) is widely used to address alcohol septal ablation (ASA) in obstructive hypertrophic cardiomyopathy (HCM). Owing to its limited cut-planes, MC-2DE may inaccurately identify the contrast misplacement associated with an unsuccessful or complicated ASA outcome. Objective: The aim of this study was to assess the added value of myocardial contrast three-dimensional echocardiography (MC-3DE) compared with MC-2DE to identify the appropriate matching between the target septal zone (TSZ) and coronary artery branch for safe and long-term effective ASA in HCM patients. Methods: A consecutive series of 52 symptomatic obstructive HCM patients referred for isolated surgical myectomy (SM) was analyzed with MC-2DE and MC-3DE following injection of echocontrast into one or more septal branches. MC-2DE and MC-3DE patterns were categorized according to complete (Type 1) or incomplete (Type 2) TSZ covering, high-risk (Type 3) exceeding TSZ, or life-threatening outside TSZ distribution (Type 4). Results: MC-2DE per patient analysis showed a Type 1 pattern in 32 patients and Types 2–4 in the remaining 20 patients; subsequent MC-3DE analysis provided a re-phenotyping of MC-2DE findings in 22 of the 52 patients (42%), showing a high-risk Type 2 pattern in 17 of the 32 patients with Type 1, and a new life-threatening Type 4 in three patients with Type 2, respectively. All patients with MC-3DE Type 1 pattern underwent safe and effective ASA with a long-term uneventful follow-up, while the remaining patients underwent SM. Conclusions: Refining high risk or life-threatening contrast misplacement, MC-3DE is more accurate than conventional MC-2DE to target safe and long-term effective septal reduction with ASA in obstructive HCM patients referred for isolated SM.

show abstract

“…Generally, LVOTO is a dynamic phenomenon and varies according to loading conditions. Reduction of preload and afterload, Valsalva maneuver, drug administration, or meals can unmask or worsen intraventricular obstruction in patients without a significant resting intraventricular gradient [ 32 , 33 ]. Detection of LVOTO at rest or through provocation maneuvers has important implications for risk stratification and decision making regarding medical therapy.…”

Section: Dynamic Left Ventricular Outflow Tract Obstruction In Takotsubo Syndromementioning

confidence: 99%

Dynamic Left Intraventricular Obstruction Phenotype in Takotsubo Syndrome

Vece

Silverio

Bellino

et al. 2021

JCM

Self Cite

View full text Add to dashboard Cite

Takotsubo syndrome (TTS) is characterized by acute, generally transient left ventricular (LV) dysfunction. Although TTS has been long regarded as a benign condition, recent evidence showed that rate of acute complications and in-hospital mortality is comparable to that of patients with acute coronary syndrome. In particular, the prevalence of cardiogenic shock ranges between 6% and 20%. In this setting, detection of mechanisms leading to cardiogenic shock can be challenging. Besides a severely impaired systolic function, onset of LV outflow tract obstruction (LVOTO) together with mitral regurgitation related to systolic anterior motion of mitral valve leaflets can lead to hemodynamic instability. Early identification of LVOTO with echocardiography is crucial and has important implications on selection of the appropriate therapy. Application of short-acting b1-selective betablockers and prudent administration of fluids might help to resolve LVOTO. Conversely, inotrope agents may increase basal hypercontractility and worsen the intraventricular pressure gradient. To date, outcomes and management of patients with TTS complicated by LVOTO as yet has not been comprehensively investigated.

show abstract

Phenotyping Left Ventricular Obstruction With Postprandial Re-Test Echocardiography in Hypertrophic Cardiomyopathy

Cited by 15 publications

References 30 publications

2 Cases of Elusive Left Ventricular Outflow Tract Gradient

2 Cases of Elusive Left Ventricular Outflow Tract Gradient

Targeting Alcohol Septal Ablation in Patients with Obstructive Hypertrophic Cardiomyopathy Candidates for Surgical Myectomy: Added Value of Three-Dimensional Intracoronary Myocardial Contrast Echocardiography

Dynamic Left Intraventricular Obstruction Phenotype in Takotsubo Syndrome

Contact Info

Product

Resources

About