Phenotyping Left Ventricular Obstruction With Postprandial Re-Test Echocardiography in Hypertrophic Cardiomyopathy
Section snippets
Methods
Four-hundred and fifty patients with HC were referred for diagnostic and therapeutic workup. Out of 450 subjects, 406 patients fulfilled HC diagnostic criteria, including an unexplained hypertrophy (maximal wall thickness > 15 mm) in the absence of other cardiac or systemic conditions capable of producing a similar degree of LV hypertrophy.17 In patients with a maximal wall thickness of 13 to 15 mm, HC was diagnosed in the presence of other markers, such as mitral valve systolic anterior motion
Results
Clinical and echocardiographic characteristics of the study group are summarized in Table 1. The occurrence of a new obstructive phenotype in the fasting condition (following Valsalva maneuver and exercise test) and at-rest re-test PP-TTE in the enrolled 92 nonobstructive HC patients is reported in Figure 1 and Table 2. A significant IVG (>30 mm Hg) was inducible at fasting TTE in 21 patients during Valsalva maneuver and 30 patients during exercise. The mechanism of LV obstruction was
Discussion
The main finding of this study is the high rate (74%) of postmeal LV obstructive re-phenotype in HC patients, without evidence of obstruction during at-rest fasting TTE. Showing a higher rate of LV obstruction than fasting Valsalva maneuver and exercise test, re-test PP-TTE may be included in clinical practice for work-up refinement in HC patients.
Dynamic LV obstruction is an important determinant of an unfavorable clinical course and should be considered a therapeutic target in HC patients.1, 2
Authors’ Contribution
Giovanni La Canna: Conceptualization, Methodology, Writing-original draft preparation, Writing- reviewing and editing. Iside Scarfò: Data curation, Software, Investigation, Project administration, Visualization, Writing-original draft preparation. Iryna Aredar: Data curation, Software, Visualization, Formal analysis. Emanuela Alati: Software, Investigation, Validation. Ilaria Caso: Visualization, Investigation, Data curation. Ottavio Alfieri: Supervision, Writing-reviewing and Editing.
Disclosures
The authors have no conflicts of interest to disclose.
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2022, JACC: Case ReportsCitation Excerpt :Common maneuvers used to provoke the gradient include exercise and the Valsalva maneuver; however, in some patients, the hemodynamic changes may manifest in the postprandial state. One study demonstrated that a postprandial echocardiogram elicits a transient LVOT gradient more effectively than post-exercise or post-Valsalva studies.3 In both of these cases, careful history taking and obtaining the correct image with the patient in the correct hemodynamic state were the essential steps in securing the diagnosis of HCM.
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