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Dynamic intracavity gradients: a 'new' hemodynamic abnormality in the spectrum of secondary left ventricular
1Klinik Martinusquelle, Bad Lippspringe, FRG.
Insights
Provocation can induce dynamic left ventricular (LV) gradients in patients with LV hypertrophy (LVH), regardless of cause. These abnormal LV outflow patterns, seen in LVH patients but not healthy individuals, were reduced by calcium antagonists.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Left ventricular hypertrophy (LVH) is associated with various cardiac conditions.
- Dynamic outflow gradients can occur in LVH, but their prevalence and triggers are not fully understood.
Purpose of the Study:
- To investigate the effect of provocative maneuvers on left ventricular (LV) outflow in patients with LVH.
- To differentiate LV outflow response to provocation between LVH patients and healthy controls.
Main Methods:
- Continuous-wave Doppler echocardiography was used to assess LV outflow.
- 93 patients with LVH (pressure overload or hypertrophic cardiomyopathy) and 39 healthy volunteers were studied.
- Provocative situations were employed to induce or accentuate LV outflow abnormalities.
Main Results:
- Outflow acceleration and gradients (19-130 mm Hg) were induced or increased in 50 LVH patients by provocation.
- LV outflow remained unchanged in healthy volunteers.
- Calcium antagonist treatment decreased the observed outflow acceleration.
Conclusions:
- Dynamic LV gradients are a non-specific finding in the spectrum of LVH.
- These abnormalities warrant consideration in the clinical evaluation of LVH patients.
- Pharmacological intervention with calcium antagonists can modulate these dynamic gradients.
Abstract:
The effect of provocation on left ventricular (LV) outflow was studied by continuous-wave Doppler echocardiography in 93 patients with LV hypertrophy (LVH), either due to pressure overload or hypertrophic cardiomyopathy (HCM), and in 39 healthy volunteers. In 50 patients with LVH, outflow acceleration (gradients ranging from 19 to 130 mm Hg) was induced or accentuated by at least one provocative situation independently of LVH aetiology. In normal persons LV outflow remained unchanged. Calcium antagonist treatment reduced outflow acceleration. It is concluded that dynamic LV gradients are a non-specific flow abnormality in the spectrum of LVH that merits consideration.