scholarly journals Exercise left ventricular outflow track obstruction in hypertrophic cardiomyopathy: Peak exercise or post-exercise pressure gradients?

2019 ◽  
Vol 11 (3) ◽  
pp. e320
Author(s):  
Y. Nahmani ◽  
N. Hammoudi ◽  
F. Huang ◽  
N. Bouziri ◽  
F. Pousset ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Left Ventricular ◽  
Peak Exercise ◽  
Pressure Gradients ◽  
Post Exercise ◽  
Left Ventricular Outflow

P886Exercise left ventricular outflow track obstruction in hypertrophic cardiomyopathy: peak exercise or post-exercise pressure gradients?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y Nahmani ◽  
N Hammoudi ◽  
F Huang ◽  
N Bouziri ◽  
F Pousset ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Time Course ◽  
Left Ventricular ◽  
New Drugs ◽  
Peak Exercise ◽  
Exercise Echocardiography ◽  
Pressure Gradients ◽  
Post Exercise ◽  
Immediate Recovery ◽  
Left Ventricular Outflow

Abstract Background Left ventricular outflow track obstruction (LVOTO) is a key feature of hypertrophic cardiomyopathy (HCM), associated with poor prognosis and requiring specific management in symptomatic patients. Furthermore, new drugs targeting LVOTO are under investigation. Exercise echocardiography is the more relevant test to unmask latent obstruction in patients with HCM and to link obstruction to symptoms during physical activity. However, little is known about the role and impact of obstruction according to the precise time of occurrence during exercise or immediate recovery. Objective We hypothesized that LVOT pressure gradients could be enhanced during immediate recovery after exercise compared to peak exercise in patients with HCM. Methods We conducted an observational, single center and retrospective study and included all the patients with HCM referred to our department between 2010 and 2018 for an exercise echocardiography. All exercises were performed on a bicycle in a semi-supine position and LVOT pressure gradient were recorded continuously during and immediately after exercise in the same position. Results 121 patients with HCM were included (age 49±16 y, 64% male, 59% NYHA 2 and 3, LV ejection fraction 66±7%, max LV wall thickness 19±5 mm, 69% receiving betablockers). Exercise was performed until exhaustion at a mean workload of 118±58 Watts. Overall, the maximal LVOT gradients increased from rest, to peak exercise and recovery (respectively 17±18, 39±43 and 55±60 mmHg, p<0,0001). More than half of the patients (52%) had a gradient ≥30 mmHg at least in one phase, but a maximal gradient ≥50 mmHg (threshold for invasive treatment in symptomatic patients) was observed in only 7% of the population at rest, 25% at peak exercise and 37% at recovery (p<0.001). Finally, a maximal gradient ≥50 mmHg was recorded only during immediate recovery (69±25 mmHg) and not during exercise in 16 patients (13%). None of them experienced post-exercise syncope. Conclusion The time course of significant LVOTO during exercise in HCM should be evaluated carefully. LVOTO is more severe and more prevalent during immediate recovery. Some patients exhibit only significant post-exercise LVOT pressure gradients, which therefore cannot explain limitation during exercise.

Evaluation of Left Ventricular Outflow Gradients During Staged Exercise Stress Echocardiography Helps Differentiate Pediatric Patients With Hypertrophic Cardiomyopathy From Athletes and Normal Subjects

2021 ◽  
pp. 1-7
Author(s):  
Mansi Gaitonde ◽  
Shannon Jones ◽  
Courtney McCracken ◽  
Matthew E. Ferguson ◽  
Erik Michelfelder ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Left Ventricular ◽  
Exercise Stress ◽  
Peak Exercise ◽  
Acceleration Time ◽  
Left Ventricular Outflow ◽  
Stage 1 ◽  
Normal Controls ◽  
Peak Gradient ◽  
Deceleration Time

Background: Elevated left ventricular outflow tract (LVOT) gradients during exercise can occur in patients with hypertrophic cardiomyopathy (HCM) as well as in athletes and normal controls. The authors’ staged exercise protocol calls for imaging at rest and during each stage of exercise to evaluate the mechanism of LVOT obstruction at each stage. They investigated whether this staged approach helps differentiate HCM from athletes and normal controls. Methods: They reviewed pediatric exercise stress echocardiograms completed between January 2009 and October 2017 at their center and identified those with gene-positive HCM, athlete’s heart, and normal controls. Children with inducible obstruction (those with no LVOT gradient at rest who developed a LVOT peak gradient > 25 mm Hg during exercise) were included. LVOT peak gradient, velocity time integral, acceleration time, and deceleration time were measured at rest, submaximal stages, and peak exercise. Results: Compared with athletes, HCM patients had significantly higher LVOT peak gradients at rest (P = .019), stage 1 of exercise (P = .002), and peak exercise (P = .051), as well as a significantly higher change in LVOT peak gradient from rest to stage 1 (P = .016) and from rest to peak (P = .038). The acceleration time/deceleration time ratio of the LVOT Doppler was significantly lower in HCM patients compared with normal controls at peak exercise. Conclusions: The HCM patients who develop elevated LVOT gradients at peak exercise typically manifest early obstruction in the submaximal stages of exercise, which helps to differentiate them from athletes and normal controls.

scholarly journals Anesthetic Challenges in the Management of Intracranial Aneurysm Clipping in a Patient with Hypertrophic Cardiomyopathy

2020 ◽  
Author(s):  
Sakshi Duggal ◽  
Priyanka Khurana ◽  
Pragati Ganjoo ◽  
Nilima Das
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Perioperative Complications ◽  
Artery Aneurysm ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Anterior Communicating Artery ◽  
Drug Selection ◽  
Aneurysm Clipping ◽  
Left Ventricular Outflow ◽  
Life Threatening

AbstractAneurysmal surgeries are high-risk procedures due to potential for occurrence of fatal perioperative complications. This risk is exaggerated in the presence of co-existing hypertrophic cardiomyopathy (HCM). It involves asymmetrical hypertrophy of left ventricle with mitral valve dysfunction, leading to left ventricular outflow tract obstruction. Various perioperative factors may precipitate this obstruction resulting in life-threatening consequences. We report the management of a patient with HCM undergoing anterior communicating artery aneurysm clipping and discuss the anesthetic concerns. Comprehensive approach with careful drug selection, vigilant monitoring, and preparedness for complications enabled patient safety and a good neurological outcome.

Angina Pectoris Due to Severe Muscular Bridge in Hypertrophic Cardiomyopathy

1998 ◽  
Vol 6 (2) ◽  
pp. 132-134
Author(s):  
M Şah Topcuoĝlu ◽  
Ayhan Usal ◽  
Cem Kayhan ◽  
Aladdin Pekedis ◽  
Acar Tokcan ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Calcium Antagonist ◽  
Hypertrophic Cardiomyopathy ◽  
Angina Pectoris ◽  
Left Ventricular Outflow Tract ◽  
Young Patients ◽  
Ventricular Outflow Tract ◽  
Myocardial Scintigraphy ◽  
Left Ventricular ◽  
Left Ventricular Outflow

We report the case of a 39-year-old male with hypertrophic cardiomyopathy who complained of angina pectoris. The patient was treated with a beta blocker and a calcium antagonist without effect. Myocardial scintigraphy revealed anterior ischemia. Cardiac catheterization and ventriculography revealed severe systolic narrowing of the left anterior descending coronary artery and no significant pressure gradient across the left ventricular outflow tract. Myotomy was performed on a muscular bridge over the left anterior descending coronary artery and the patient's angina was relieved. In young patients with hypertrophic cardiomyopathy who develop angina refractory to medical therapy, a coexisting muscular bridge should be sought.

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