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Sublingual isosorbide dinitrate for the detection of obstruction in hypertrophic cardiomyopathy

David Zemánek1, Pavol Tomasov, Stanislava Homolová

  • 1Department of Cardiology, University Hospital Motol, First and Second Medical School of Charles University, V Uvalu 84, 150 21 Prague, Czech Republic. zejada@seznam.cz

European Journal of Echocardiography : the Journal of the Working Group on Echocardiography of the European Society of Cardiology
|August 9, 2011
PubMed

Insights

The isosorbide dinitrate (ISDN) spray test effectively detects left ventricular outflow tract (LVOT) obstruction in hypertrophic cardiomyopathy (HCM) patients. Optimal detection occurs 5-10 minutes post-administration, with negative tests warranting further exercise echocardiography.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Pharmacological Stress Testing

Background:

  • Hypertrophic cardiomyopathy (HCM) frequently presents with left ventricular outflow tract (LVOT) obstruction.
  • Provocative testing is crucial for routine HCM evaluation to assess obstruction.
  • Sublingual isosorbide dinitrate (ISDN) spray is a potential agent for obstruction provocation.

Purpose of the Study:

  • To evaluate the diagnostic utility of sublingual ISDN spray for detecting LVOT obstruction in HCM patients.
  • To determine the optimal timing for LVOT gradient measurement after ISDN administration.
  • To compare the efficacy of ISDN testing with rest and exercise echocardiography.

Main Methods:

  • Prospective analysis of 77 consecutive HCM patients.
  • Measurement of LVOT gradient at rest, after ISDN spray (2.5 mg at 2, 5, and 10 minutes), and during exercise echocardiography.
  • Definition of obstruction as a gradient ≥ 30 mmHg.

Main Results:

  • Resting LVOT obstruction was present in 19% of patients.
  • ISDN testing revealed obstruction in 55% of patients, with peak detection at 5-10 minutes.
  • Exercise echocardiography identified obstruction in 71% of patients.
  • ISDN test demonstrated 76% sensitivity and 100% specificity compared to exercise testing.

Conclusions:

  • Sublingual ISDN spray is a reliable screening tool for HCM-related LVOT obstruction.
  • LVOT gradient measurement should be performed 5-10 minutes after ISDN spray application.
  • Patients with a negative ISDN test result should proceed to exercise echocardiography for definitive assessment.
Abstract

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