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Dynamic left ventricular outflow tract obstruction evoked by exercise echocardiography: prevalence and predictive

K Zywica1, R Jenni, P A Pellikka

  • 1Cardiovascular Center Zurich, Klinik Im Park, Zurich, Switzerland.

European Journal of Echocardiography : the Journal of the Working Group on Echocardiography of the European Society of Cardiology
|May 21, 2008
PubMed

Insights

Dynamic left ventricular outflow tract obstruction (DLVOTO) can cause ischemia in patients without hypertrophic obstructive cardiomyopathy (HOCM). Key predictors include chordal systolic anterior motion of the mitral valve, smaller left ventricles, and increased septal wall thickness.

Area of Science:

  • Cardiology
  • Echocardiography
  • Hemodynamics

Background:

  • Dynamic left ventricular outflow tract obstruction (DLVOTO) can cause ischemia, but its incidence and predictors in patients without hypertrophic obstructive cardiomyopathy (HOCM) are poorly understood.
  • Understanding DLVOTO in non-HOCM patients is crucial for accurate diagnosis and management of cardiac ischemia.

Purpose of the Study:

  • To determine the incidence and identify predictors of exercise-induced DLVOTO in patients without HOCM.
  • To investigate the association between DLVOTO and ischemic symptoms or echocardiographic findings.

Main Methods:

  • Prospective study of 280 patients undergoing exercise echocardiography.
  • Assessment of DLVOTO and systolic anterior motion of the mitral valve (SAM) at rest, during Valsalva maneuver, and post-exercise.
  • Definition of significant DLVOTO as Doppler velocity ≥2.5 m/s (25 mmHg) post-exercise.

Main Results:

  • Significant exercise-induced DLVOTO occurred in 5% (13 patients) without HOCM.
  • Independent predictors of DLVOTO included chordal SAM, smaller end-systolic left ventricle, higher peak systolic blood pressure, younger age, and increased septal wall thickness.
  • DLVOTO was a potential cause of symptoms or ischemia in at least 6 of the 13 affected patients.

Conclusions:

  • Hemodynamically significant exercise-induced DLVOTO can occur in the absence of HOCM.
  • Chordal SAM, small and hyperdynamic left ventricles, increased septal wall thickness, and younger age are significant predictors of exercise-induced DLVOTO.
Abstract

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