Related Experiment Video
Updated: Jun 22, 2025
A Model of Cardiac Remodeling Through Constriction of the Abdominal Aorta in Rats
Published on: December 2, 2016
Changes in left ventricular-aortic angulation are associated with the development of obstruction in hypertrophic
Defne Gunes Ergi1, Hartzell V Schaff1, Steven R Ommen2
1Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
Insights
Hypertrophic cardiomyopathy patients who develop left ventricular outflow tract obstruction show increased ventricular angulation and hypertrophy. Mitral valve changes were not associated with obstruction progression.
Area of Science:
- Cardiology
- Cardiac Imaging
- Cardiovascular Disease
Background:
- Hypertrophic cardiomyopathy (HCM) is a genetic heart muscle disease.
- Left ventricular (LV) outflow tract obstruction can develop in HCM patients.
- Understanding morphological changes is crucial for managing HCM progression.
Purpose of the Study:
- To characterize ventricular morphological changes in HCM patients who develop LV outflow tract obstruction.
- To compare these changes with HCM patients who remain nonobstructive.
Main Methods:
- Retrospective review of HCM patients undergoing septal myectomy (May 2012-June 2023).
- Comparison between patients who developed obstruction and those who remained nonobstructive.
- Matched-pair analysis based on sex, age, and initial septal wall thickness.
- Analysis of echocardiographic data, including 5 measures of angulation.
Main Results:
- Patients with obstruction had a greater increase in LV mass compared to nonobstructive patients.
- Significant increase in aortic angulation observed in 4 of 5 measurements in the obstruction group.
- Septal wall thickness increased in both groups, but the magnitude of increase did not differ.
- Hypertension was more prevalent in patients who developed obstruction.
Conclusions:
- Development of LV outflow tract obstruction in HCM is linked to progressive LV angulation and increased LV hypertrophy (LV mass).
- Mitral valve leaflet morphology and coaptation length did not significantly change and were not related to obstruction progression.
Objective:
To characterize changes in ventricular morphology in patients with hypertrophic cardiomyopathy who develop left ventricular (LV) outflow tract obstruction.
Methods:
We reviewed patients with hypertrophic cardiomyopathy with LV outflow tract obstruction who underwent septal myectomy from May 2012 to June 2023. Among 68 patients initially without obstruction documented up to 7.6 years (interquartile range, 6.3-9.4 years) before the operation, a comparison was made with 78 patients with nonobstructive hypertrophic cardiomyopathy over a similar period. Patients who did not develop obstruction were matched with those who did on sex, age, and maximum septal wall thickness during the initial echocardiography, identifying 41 matched pairs. Echocardiographic data, including 5 measures of angulation, were compared between the groups.
Results:
The median interval between echocardiographic assessments was 7.5 years (interquartile range, 6.3-8.1 years) among patients with obstruction versus 7.3 years (interquartile range, 6.2-9.0 years) in patients without nonobstruction. Patients with obstruction were more likely to have hypertension at both times. The maximum septal wall thickness increased within both groups (both P values < .001), but the magnitude of increase was not different between groups (P = .130). Patients with obstruction exhibited a greater increase in LV mass (P < .001) compared with patients without obstruction (P = .004). Aortic angulation significantly increased in 4 of the 5 measurements (all P values < .001) in patients with obstruction, whereas patients with no obstruction showed no change. Anterior and posterior mitral valve leaflet lengths and coaptation lengths remained similar in both groups over time.
Conclusions:
The development of LV outflow tract obstruction in patients with hypertrophic cardiomyopathy was associated with progressive LV outflow tract angulation and increased LV hypertrophy, as reflected by LV mass. Progression to obstruction was not related to changes in the mitral valve leaflet morphology.
Related Concept Videos
01:26Imbalances in Cardiac Output
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...
01:17Pathophysiology of Heart Failure