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.
The pulmonary venous flow patterns of two patients with severe aortic regurgitation (AR) (one with 2+ diastolic, 2+/3+ systolic mitral regurgitation (MR), the other with minimal diastolic and 1+/2+ systolic MR) was examined with TEE, A reduced systolic forward flow and an accentuated diastolic reversal flow were found in each case, irrespective of the amount of MR. According to the first impression it could perhaps be possible to judge the amount of AR on the basis of the VTI measurement of the pulmonary venous flow pattern. ( E C H O C A R D I O G R A P~, Volume 12, May 1995) pulmonary venous flow, TEE, aortic regurgitation, reversal flow
These findings show that provokable LVOT gradients are likely to occur during exercise to a similar degree as those on preload reduction. Thus, course of disease could possibly be influenced by early treatment in patients with left ventricular hypertrophy.
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