Evaluation of Left Ventricular Outflow Tract Gradient During Treadmill Exercise and in Recovery Period in Orthostatic Position, in Patients with Hypertrophic Cardiomyopathy

Overview

Journal Cardiovasc Ultrasound

Publisher Biomed Central

Specialties Cardiology & Vascular Diseases
Radiology

Date 2008 May 17

PMID 18482456

Citations 11

Authors

Rita Miranda

Carlos Cotrim

Nuno Cardim

Sofia Almeida

Luis Lopes

Maria Jose Loureiro

Otilia Simoes

Pedro Cordeiro

Paula Fazendas

Isabel Joao

Manuel Carrageta

Affiliations

Soon will be listed here.

Abstract

Background: Left ventricular outflow tract obstruction is an independent predictor of adverse outcome in hypertrophic cardiomyopathy (HCM). The classical quantification of intraventricular obstruction is performed in resting conditions in supine position, but this assessment does not reflect what happens in HCM patients (pts) in their daily activities, neither during effort nor during orthostatic recovery.

Aim: To assess intraventricular gradients with echocardiography during treadmill exercise and in the recovery period in upright position, in HCM pts.

Methods: We studied 17 HCM pts (9 males, mean age 53 +/- 16 years, 11 with obstructive HCM). Each pt had 2 echocardiographic evaluations at rest (left lateral decubitus (LLD) and orthostatic position). The pts then underwent a treadmill exercise test and intraventricular gradients were measured at peak exercise and during recovery in orthostatic position.

Results: 3 pts with non-obstructive HCM at rest developed intraventricular gradients during exercise. 1 pt developed this gradient only during orthostatic recovery. The mean intraventricular gradient in LLD was 49 +/- 24 mmHg; in orthostatic position was 62 +/- 29 mmHg (p < 0.001 versus in LLD); at peak exercise was 83 +/- 35 mmHg (p < 0.001 versus supine rest); during recovery it was 96 +/- 35 mmHg (p < 0.001 versus peak exercise)

Conclusion: In HCM pts the intraventricular gradient increases in orthostatic position, increases significantly during treadmill exercise and continues increasing in the recovery period in orthostatic position. This type of evaluation can help us to better understand the physiopathology, the symptoms and the efficacy of different therapeutic modalities in this disease and should be routinely used in the assessment of HCM pts.

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