Venous dysfunction in obstructive hypertrophic cardiomyopathies: Results from the "HCM-Vein" pilot study

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Patricia Réant1,2,3,4,5, Guillaume Bonnet1,2,3,4,5, Charles Massie1,2,6

  • 1Bordeaux University Hospital, 33000 Bordeaux, France.

International Journal of Cardiology. Heart & Vasculature
|March 30, 2023
PubMed

Insights

About 30% of hypertrophic cardiomyopathy patients with outflow obstruction show venous dysfunction, often linked to smaller left ventricular volumes. Further research is needed to understand this connection in hypertrophic cardiomyopathy (HCM).

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Genetics

Background:

  • Hypertrophic cardiomyopathy (HCM) can lead to left ventricular outflow-tract obstruction (LVOTO).
  • LVOTO causes exercise symptoms and is influenced by hemodynamic factors like venous return.
  • Venous dysfunction may play a role in HCM-related LVOTO.

Purpose of the Study:

  • To compare venous dysfunction in obstructive HCM patients versus healthy controls.
  • To explore the relationship between venous dysfunction and LVOTO in HCM patients.

Main Methods:

  • A monocentric, prospective, pilot study involving 30 obstructive HCM patients and 10 healthy controls.
  • Venous function assessed using venous air plethysmography.
  • Endothelial function and venous air plethysmography were investigated.

Main Results:

  • 30% of obstructive HCM patients exhibited abnormal venous residual volume fraction (RVFv), indicating elevated venous pressure, compared to 0% in controls (p < 0.05).
  • HCM patients with abnormal RVFv had significantly smaller left ventricular end-diastolic volume index (40.1 vs. 50.2 ml/m², p=0.01).
  • Abnormal RVFv was associated with a higher incidence of increased Willebrand factor (56% vs. 26%, p < 0.05).

Conclusions:

  • Venous insufficiency affects approximately 30% of symptomatic obstructive HCM patients.
  • Venous insufficiency in HCM may be associated with smaller left ventricular cavity volumes.
  • This pilot study is hypothesis-generating, requiring further investigation due to its small sample size.
Abstract

Keywords:
Endothelial dysfunctionHypertrophic cardiomyopathyLeft ventricular outflow-tract obstructionVenous return

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