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Outflow acceleration assessed by continuous-wave doppler echocardiography in left ventricular hypertrophy: an
1Department of Cardiology, Heart Center NRW, Ruhr University of Bochum, Bad Oeynhausen, Germany.
Insights
Provocation can induce or worsen left ventricular (LV) outflow acceleration in patients with LV hypertrophy (LVH). This dynamic gradient is a common, nonspecific finding in LVH, influenced by factors like sex and LV size.
Area of Science:
- Cardiology
- Echocardiography
- Physiology
Background:
- Left ventricular hypertrophy (LVH) is a condition affecting the heart's main pumping chamber.
- Understanding outflow dynamics in LVH is crucial for patient management.
Purpose of the Study:
- To investigate the effect of provocation on left ventricular (LV) outflow in patients with LVH.
- To identify factors associated with LV outflow acceleration.
Main Methods:
- Continuous-wave Doppler echocardiography was used in 103 patients with LVH.
- The Valsalva maneuver and nitroglycerin were employed as provocative agents.
Main Results:
- Outflow acceleration was induced or accentuated in 34 patients (33%).
- Associated factors included female sex, smaller LV cavity size, and increased LV contractility.
- Dynamic intracavity LV gradients were observed independent of LVH etiology.
Conclusions:
- Dynamic LV gradients are a nonspecific but frequent finding in LVH.
- These gradients warrant consideration in the assessment of LVH patients.
Abstract:
The effect of provocation on left ventricular (LV) outflow was studied by continuous-wave Doppler echocardiography in 103 nonselected, consecutively enrolled patients with LV hypertrophy (LVH), either due to pressure overload (97 patients) or hypertrophic cardiomyopathy (HCM, 6 patients). In 34 patients with LVH, outflow acceleration (gradients ranging from 18 to 122 mm Hg) was induced or accentuated by the Valsalva maneuver after 1.6 mg nitroglycerine sublingually independent of LVH etiology. Factors associated with LV outflow acceleration were female sex, small body surface area and LV cavity size, increased relative wall thickness, LV contractility, and resting LV outflow velocity, mitral anulus calcifications and systolic anterior movement of the mitral valve. It is concluded that dynamic, intracavity LV gradients are a nonspecific flow abnormality that merit consideration because they can be frequently found in LVH patients.