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Basic echocardiographic features of patients with latent left ventricular outflow tract obstruction without left

Hiroaki Semba1, Hitoshi Sawada, Tokuhisa Uejima

  • 1Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.

International Heart Journal
|August 11, 2012
PubMed

Insights

Latent left ventricular outflow tract obstruction (L-LVOTO) can occur in patients without left ventricular hypertrophy (LVH). The LVOT ratio is a key predictor for identifying L-LVOTO in non-LVH patients undergoing dobutamine stress echocardiography.

Area of Science:

  • Cardiology
  • Echocardiography
  • Medical Diagnostics

Background:

  • Left ventricular outflow tract obstruction (LVOTO) is often associated with hypertrophic cardiomyopathy (HCM) or left ventricular hypertrophy (LVH).
  • Latent LVOTO (L-LVOTO) can be provoked by exertion and may occur in patients without LVH (non-LVH).
  • The prevalence and prognosis of L-LVOTO in non-LVH patients remain unclear.

Purpose of the Study:

  • To investigate echocardiographic features of L-LVOTO in non-LVH patients with malignancy.
  • To identify predictors of L-LVOTO in this patient cohort.
  • To evaluate the utility of dobutamine stress echocardiography (DSE) for detecting L-LVOTO.

Main Methods:

  • Retrospective analysis of 199 patients with malignancy, without LVH or coronary artery disease, who underwent DSE.
  • Comparison of baseline echocardiographic features between patients with and without L-LVOTO post-DSE.
  • Calculation of the left ventricular outflow tract (LVOT) ratio (systolic/diastolic diameter) as a potential predictor.

Main Results:

  • 106 out of 199 patients (53.3%) developed L-LVOTO after DSE.
  • A baseline LVOT ratio ≤ 0.83 was identified as a significant predictor of L-LVOTO (sensitivity 81.1%, specificity 80.6%).
  • The LVOT ratio strongly correlated with the presence of L-LVOTO in non-LVH patients.

Conclusions:

  • L-LVOTO is prevalent in nearly half of non-LVH patients with malignancy.
  • The baseline LVOT ratio is a reliable indicator for detecting L-LVOTO in this population.
  • DSE is valuable for identifying dynamic LVOT narrowing and L-LVOTO in non-LVH patients.

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