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Left ventricular outflow tract gradient variability in hypertrophic cardiomyopathy

Jeffrey B Geske1, Paul Sorajja, Steve R Ommen

  • 1Division of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.

Clinical Cardiology
|July 18, 2009
PubMed

Insights

Left ventricular outflow tract (LVOT) obstruction in hypertrophic cardiomyopathy (HCM) varies significantly day-to-day. This variability impacts clinical decisions for managing HCM patients with LVOT obstruction.

Area of Science:

  • Cardiology
  • Cardiovascular Medicine
  • Medical Diagnostics

Background:

  • Symptomatic hypertrophic cardiomyopathy (HCM) management relies on assessing left ventricular outflow tract (LVOT) obstruction.
  • The dynamic nature of LVOT obstruction, influenced by ventricular load and contractility, is known but its day-to-day variability is underappreciated.

Purpose of the Study:

  • To investigate the impact of LVOT gradient variability on clinical decision-making in hypertrophic cardiomyopathy patients.
  • To quantify the day-to-day variability of LVOT obstruction measurements in HCM.

Main Methods:

  • 100 hypertrophic cardiomyopathy patients underwent serial 2D Doppler transthoracic echocardiography and cardiac catheterization within 48 hours.
  • Transseptal left-sided pressure measurements were obtained during catheterization.
  • Simultaneous LVOT gradient measurements were performed in a subset of 15 patients to validate Doppler accuracy.

Main Results:

  • LVOT gradients showed wide variability between methods, with 95% confidence limits of agreement of +/- 84 mm Hg.
  • A significant 21% of patients were discrepantly classified regarding severe LVOT obstruction (>= 30 mm Hg) based on measurements.
  • Simultaneous measurements confirmed high accuracy of Doppler, with 95% confidence limits of agreement +/- 12 mm Hg.

Conclusions:

  • LVOT gradient measurements are crucial for characterizing obstruction severity in HCM.
  • Marked day-to-day variability in LVOT obstruction exists in HCM patients.
  • This variability must be carefully considered when determining therapeutic strategies for symptomatic HCM patients.
Abstract

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