Resting Echocardiographic Features of Latent Left Ventricular Outflow Obstruction in Hypertrophic Cardiomyopathy * *This study was supported in part by a grant from the Uehara Memorial Foundation, Tokyo, Japan.

Nakatani, Satoshi; Marwick, Thomas H.; Lever, Harry M.; Thomas, James D.

doi:10.1016/s0002-9149(96)00386-6

Cited by 44 publications

(5 citation statements)

References 27 publications

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“…The average E¢ velocity (E¢av) was obtained from the septal and lateral annular E¢ velocities, and the ratio of the mitral inflow E velocity to average tissue Doppler velocity (E/E¢av) was calculated to predict LV filling pressure (13). Dynamic obstruction of the LVOT was measured using continuous wave Doppler and estimated using the simplified Bernoulli equation (14). …”

Section: Methodsmentioning

confidence: 99%

Galectin-3 levels in patients with hypertrophic cardiomyopathy and its relationship with left ventricular mass index and function

Tülüce

Çil³

et al. 2015

Anatol J Cardiol

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Objective:Cardiac fibrosis is an important contributor to adverse left ventricular (LV) remodeling and arrhythmias in patients with hypertrophic cardiomyopathy (HCM). Galectin-3 (Gal-3) is a novel marker of cardiac fibrosis and inflammation. In this study, we investigated Gal-3 levels in patients with HCM and controls and assessed the relationship between Gal-3 level and echocardiographic indices using strain echocardiography in patients with HCM.Methods:Forty patients with HCM in sinus rhythm and 35 healthy controls were prospectively enrolled in this case-control study. The HCM diagnosis was based on two-dimensional echocardiographic demonstration of a hypertrophied and non-dilated left ventricle (LV) with a wall thickness ≥15 mm in one or more LV myocardial segments in the absence of any cardiac or systemic disease capable of inducing LV hypertrophy. Patients with one of the followings were excluded: coronary artery disease, atrial fibrillation episodes on 24-h Holter electrocardiogram (ECG) monitoring, history of an invasive intervention to alleviate an LV outflow (LVOT) obstruction, inadequate image quality, renal disease, diabetes mellitus, hyperlipidemia, liver cirrhosis, and pulmonary fibrosis. Global LV longitudinal, circumferential strain and strain rates, peak torsion, and LV mass index (LVMI) of all subjects were assessed by echocardiography. Gal-3 levels were measured in all subjects.Results:Left ventricular global longitudinal strain (-13.37±4.6% vs. -18.93±2.5%, p<0.001) and strain rate (0.66±0.22 s-1 vs. 1.08±0.14 s-1, respectively; p<0.001) values were lower in patients with HCM than in controls. Gal-3 levels were significantly higher in patients with HCM than in controls (16.9±6.64 ng/mL vs. 13.21±3.42 ng/mL, p=0.005). Gal-3 levels were associated with the thickness of the interventricular septum (r=0.444, p=0.004) and LVMI (r=0.365, p=0.021); however, they were not associated with LV global longitudinal strain (p=0.42) or strain rate (p=0.28).Conclusion:Gal-3 levels increased and were correlated with the degree of LV hypertrophy in patients with HCM. Gal-3 is not a good marker of decreased myocardial LV diastolic and systolic functions in these patients.

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Section: Methodsmentioning

confidence: 99%

Galectin-3 levels in patients with hypertrophic cardiomyopathy and its relationship with left ventricular mass index and function

Tülüce

Çil³

et al. 2015

Anatol J Cardiol

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“…Mechanisms of LVOT obstruction are diverse among patients. As also described in the Discussion section of this case report, not only LV size, LV systolic function, and basal septal bulge due to true septal hypertrophy or sigmoid septum but also papillary muscle displacement, increased mitral leaflet area, and both Venturi and drag forces were considered as contributing factors of SAM, the following LVOT obstruction, and MR [2] , [3] , [4] , [11] , [12] , [14] , [15] . Preload reduction, afterload reduction, and the hyperadrenergic state due to exercise, inotropic agents, or worsening heart failure can modify the LV size and contractility.…”

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confidence: 62%

“…Patients with obstructive HCM show mitral valve systolic anterior motion (SAM) that is determined largely by the interrelation of LVOT geometry, the size and mobility of the mitral leaflets, and the presence and distribution of fibrous thickening [2] . In addition, both Venturi and drag forces also play a role in inducing mitral valve SAM and the following LVOT obstruction [3] , [4] . It should be noted that mitral regurgitation (MR) in varying degrees is found in obstructive HCM patients with or without association with structural deformities of the valve apparatus.…”

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confidence: 99%

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Editorial: Left ventricular outflow tract obstruction is seen in various clinical settings of diverse patients

Abe

2016

Journal of Cardiology Cases

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“…20 Resting LVOT peak velocity was measured by using continuous‐wave Doppler echocardiography, and resting LVOT pressure gradient was estimated by using a simplified Bernoulli equation. 21 In patients with resting LVOT gradients <30 mm Hg, provocative maneuvers, including Valsalva, amyl nitrite, and exercise echocardiography, were also used to measure a provocable LVOT gradient. Maximal LVOT gradient was recorded and defined as the highest recorded gradient (either resting or provoked) in a given patient.…”

Section: Methodsmentioning

confidence: 99%

Association of Noninvasively Measured Left Ventricular Mechanics With In Vitro Muscle Contractile Performance: A Prospective Study in Hypertrophic Cardiomyopathy Patients

Dhillon

Sweet

Popović

et al. 2014

JAHA

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BackgroundHypertrophic cardiomyopathy (HCM) is a primary myopathic process in which regional left ventricular dysfunction may exist without overt global left ventricular dysfunction. In obstructive HCM patients who underwent surgical myectomy (SM), we sought to determine if there is a significant association between echocardiographic longitudinal strain, histopathology, and in vitro myocardial performance (resting tension and developed tension) of the surgical specimen.Methods and ResultsHCM patients (n=122, 54±14 years, 54% men) undergoing SM were prospectively recruited. Longitudinal systolic strain and diastolic strain rates were measured at that basal septum (partially removed at SM) by using velocity vector imaging on preoperative echocardiography. Semiquantitative histopathologic grading of myocyte disarray and fibrosis and in vitro measurements of resting tension and developed tension were made in septal tissue obtained at SM. Mean basal septal systolic strain and diastolic strain rate were −8.3±5% and 0.62±0.4/s, while mild or greater degree of myocyte disarray and interstitial fibrosis were present in 85% and 87%, respectively. Mean resting tension and developed tension were 2.8±1 and 1.4±0.8 g/mm2. On regression analysis, basal septal systolic strain, diastolic strain rate, disarray, and fibrosis were associated with developed tension (β=0.19, 0.20, −0.33, and −0.40, respectively, all P<0.01) and resting tension (β=0.21, 0.22, −0.25, and −0.28, respectively, all P<0.01).ConclusionIn obstructive HCM patients who underwent SM, left ventricular mechanics (echocardiographic longitudinal systolic strain and diastolic strain rates), assessed at the basal septum (myocardium removed during myectomy) and histopathologic findings characteristic for HCM (disarray and fibrosis) were significantly associated with in vitro myocardial resting and developed contractile performance.

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Resting Echocardiographic Features of Latent Left Ventricular Outflow Obstruction in Hypertrophic Cardiomyopathy * *This study was supported in part by a grant from the Uehara Memorial Foundation, Tokyo, Japan.

Cited by 44 publications

References 27 publications

Galectin-3 levels in patients with hypertrophic cardiomyopathy and its relationship with left ventricular mass index and function

Galectin-3 levels in patients with hypertrophic cardiomyopathy and its relationship with left ventricular mass index and function

Editorial: Left ventricular outflow tract obstruction is seen in various clinical settings of diverse patients

Association of Noninvasively Measured Left Ventricular Mechanics With In Vitro Muscle Contractile Performance: A Prospective Study in Hypertrophic Cardiomyopathy Patients

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