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Hemodynamics and coronary angiography in idiopathic hypertrophic subaortic stenosis
Insights
Idiopathic hypertrophic subaortic stenosis (IHSS) commonly presents with left ventricular outflow tract obstruction. Coexistent coronary atherosclerosis is often incidental, but severe cases may reduce the intraventricular gradient.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Medical Diagnostics
Background:
- Idiopathic hypertrophic subaortic stenosis (IHSS) is a significant cardiovascular condition.
- Understanding the hemodynamics and associated pathologies of IHSS is crucial for patient management.
Purpose of the Study:
- To investigate the hemodynamic characteristics of patients with IHSS.
- To determine the prevalence and impact of coexistent coronary atherosclerosis in IHSS patients.
Main Methods:
- Cardiac catheterization was performed on 118 patients with IHSS.
- Coronary arteriography was utilized to assess coronary artery status.
- Right heart catheterization was conducted in a subset of patients.
Main Results:
- A significant left ventricular outflow tract gradient was observed in 112 patients.
- Mild, hemodynamically insignificant right ventricular outflow tract gradients were noted in 17 patients.
- Left ventricular end-diastolic pressure was elevated in 80% of patients, and 60% had mild mitral regurgitation.
- Coronary atherosclerosis was present in nearly 20% of patients, with a higher incidence in those over 40.
- Severe coronary atherosclerosis was associated with a lower resting intraventricular gradient.
Conclusions:
- IHSS frequently involves left ventricular outflow tract obstruction and elevated filling pressures.
- Coronary atherosclerosis in IHSS patients is often coincidental.
- Objective evaluation of the coronary circulation is recommended in IHSS patients, particularly those with severe coronary disease.
Abstract:
One hundred eighteen patients with idiopathic hypertrophic subaortic stenosis were studied with cardiac catheterization and coronary arteriography. In 112 a gradient across the left ventricular outflow tract was present in the resting state. Seventeen of the 61 patients who had right heart catheterization had a mild resting gradient across the right ventricular outflow tract, that was considered clinically and hemodynamically insignificant. Ninety-five patients (80 percent) had a left ventricular end-diastolic pressure greater than 10 mm Hg; 60 percent had mitral regurgitation that was of mild degree in most cases. Almost 20 percent had coexistent coronary atherosclerosis (25 percent incidence rate in subjects aged 40 years or older). Patients with associated severe coronary atherosclerosis had a lower intraventricular gradient at rest than other patients. Coronary atherosclerosis appears to be a coincidental condition. The need for objective evaluation of the coronary circulation is emphasized.