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Steep left ventricle to aortic root angle and hypertrophic obstructive cardiomyopathy: study of a novel association

D H Kwon1, N G Smedira, Z B Popovic

  • 1Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, USA.

Heart (British Cardiac Society)
|June 25, 2009
PubMed

Insights

Patients with hypertrophic cardiomyopathy (HCM) have a steeper left ventricle to aortic root angle, which predicts left ventricular outflow tract (LVOT) obstruction. This finding is independent of basal septal thickness (BST).

Area of Science:

  • Cardiology
  • Medical Imaging
  • Cardiovascular Disease

Background:

  • Hypertrophic cardiomyopathy (HCM) is associated with left ventricular outflow tract (LVOT) obstruction.
  • LVOT obstruction in HCM can occur independently of basal septal thickness (BST).
  • A steeper left ventricle to aortic root angle has been observed in some HCM patients.

Purpose of the Study:

  • To identify predictors of the left ventricle to aortic root angle.
  • To determine the association between the left ventricle to aortic root angle and LVOT obstruction.
  • To utilize three-dimensional imaging techniques for these investigations.

Main Methods:

  • Whole-heart three-dimensional cardiac magnetic resonance (CMR) angiography and Doppler echocardiography were performed.
  • 153 HCM patients, 62 elderly hypertensive heart disease patients, and 42 healthy controls were studied.
  • Measurements included LV-aortic root angle, basal septal thickness (BST), and maximal non-exercise LVOT gradient.

Main Results:

  • The mean LV-aortic root angle differed significantly across the three groups (HCM: 134°, hypertensive-elderly: 128°, control: 140°).
  • An inverse correlation was found between age and LV-aortic root angle in all groups (p<0.001).
  • In HCM patients, LV-aortic root angle, age, and end-systolic volume index were associated with LVOT gradient; only LV-aortic root angle remained significant in multivariate analysis.

Conclusions:

  • Patients with HCM exhibit a steeper LV-aortic root angle compared to controls.
  • A steeper LV-aortic root angle is a predictor of dynamic LVOT obstruction in HCM patients.
  • This predictive association is independent of basal septal thickness (BST).
Abstract

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