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Causes of an increased pressure gradient through the left ventricular outflow tract: a West Coast experience

Sayuki Kobayashi1,2, Yoshihiko Sakai3, Isao Taguchi3

  • 1Center of Medical Ultrasonics, Koshigaya Hospital, Dokkyo Medical University, Saitama, Japan. sayuki@dokkyomed.ac.jp.

Journal of Echocardiography
|September 19, 2017
PubMed

Insights

Left ventricular outflow tract obstruction (LVOTO) has diverse causes beyond hypertrophic obstructive cardiomyopathy. Many patients with LVOTO experienced significant improvement with medical and procedural interventions.

Area of Science:

  • Cardiology
  • Echocardiography
  • Cardiovascular Medicine

Background:

  • Left ventricular outflow tract obstruction (LVOTO) can arise from various conditions, not solely hypertrophic obstructive cardiomyopathy (HOCM).
  • The specific changes in LVOT pressure gradient (LVOT PG) across different LVOTO etiologies are not well-defined.
  • Understanding diverse LVOTO causes is crucial for effective management.

Purpose of the Study:

  • To investigate the clinical characteristics and echocardiographic parameters of patients with significant LVOTO.
  • To identify the various underlying conditions contributing to LVOTO.
  • To assess the outcomes of interventions for LVOTO.

Main Methods:

  • Retrospective analysis of 73 patients with LVOT PG ≥50 mmHg at rest via Doppler ultrasound.
  • Evaluation of clinical data, including comorbidities like hypertension and anemia.
  • Assessment of echocardiographic parameters and follow-up data.

Main Results:

  • The study included patients aged 69 ± 15 years, with 38% males.
  • Hypertension (66%) and anemia (43%) were common comorbidities.
  • Hypertrophic obstructive cardiomyopathy (HOCM) was the most frequent cause (74%), followed by hypertensive left ventricular hypertrophy (9%), post-open heart surgery (7%), and sigmoid septum (4%).
  • Significant improvement or reduction in LVOTO was achieved in 93% of cases at follow-up (mean 44 months) with medical and transcatheter treatments.

Conclusions:

  • LVOTO presents with diverse underlying causes, often involving a combination of intrinsic cardiac morphology and hemodynamic factors.
  • Effective management requires identifying specific etiological factors.
  • Tailored therapeutic approaches are essential for improving individual patient outcomes in LVOTO.
Abstract

Keywords:
EchocardiographyLeft ventricular outflow tract obstructionLeft ventricular outflow tract pressure gradientNegative inotropic agents

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