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Left ventricular outflow obstruction occurs immediately after exercise in patients with non-obstructive hypertrophic

Jong-Youn Kim1, Eui-Young Choi1, Wonho Kim2

  • 1Cardiology Division, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 06273 Seoul, Republic of Korea.

Reviews in Cardiovascular Medicine
|July 14, 2021
PubMed

Insights

Latent obstruction (LO) in hypertrophic cardiomyopathy (HCMP) often occurs after exercise, not during. Key indicators for LO include longer mitral leaflets and higher resting gradients.

Area of Science:

  • Cardiology
  • Echocardiography
  • Cardiovascular Physiology

Background:

  • Hypertrophic cardiomyopathy (HCMP) is a genetic heart muscle disease.
  • Non-obstructive HCMP can develop latent obstruction (LO) under stress.
  • Understanding LO determinants is crucial for patient management.

Purpose of the Study:

  • To identify hemodynamic and geometric factors predicting latent obstruction in non-obstructive HCMP.
  • To analyze the timing of peak trans-left ventricular outflow tract (LVOT) gradients during exercise protocols.
  • To correlate specific echocardiographic parameters with the development of LO.

Main Methods:

  • 35 patients with non-obstructive HCMP underwent stepwise supine bicycle exercise echocardiography.
  • Measured trans-LVOT pressure gradients, mitral leaflet length, LV ejection fraction (LVEF), and LV dimensions (LVESD, LVEDD).
  • Compared parameters between patients who developed LO and those who did not.

Main Results:

  • The highest trans-LVOT gradients predominantly occurred immediately post-exercise (91.3%).
  • Nine patients (25%) developed significant LO.
  • Patients with LO had longer residual mitral leaflets and higher resting LVOT gradients compared to non-LO patients.

Conclusions:

  • Peak trans-LVOT gradients in HCMP often manifest immediately after exercise.
  • Abrupt decreases in mitral annular diameter post-exercise, longer residual mitral leaflets, and higher resting LVOT gradients are associated with LO development.

Keywords:
Latent obstructionNon-obstructive hypertrophic cardiomyopathy

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