Dobutamine Stress Echocardiography Unmasks Acute Worsening of Mitral Regurgitation with Latent Left Ventricular Outflow Tract Obstruction Behind Diastolic Heart Failure in Hypertensive Heart Disease

Fujino, Masashi; Kanzaki, Hideaki; Tanaka, Jun; Ohara, Takahiro; Kim, Jiyoong; Hashimura, Kazuhiko; Nakatani, Satoshi; Ikeda, Yoshihiko; Ueda-Ishibashi, Hatsue; Kitakaze, Masafumi

doi:10.2169/internalmedicine.48.1530

Cited by 6 publications

(7 citation statements)

References 16 publications

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“…Since the prevalence of latent LVOT obstructions in our SVS group was higher than expected, attention should be paid to SVSs (especially if they are associated with a short "˛" distance) due to the possibility of a latent LVOT obstruction. As previously reported [4,5,24], beta-blockers or class I antiarrhythmic drugs may be effective for patients with an SVS who have cardiac symptoms and/or a short "˛" distance. Although we only investigated 8 subjects, we found that beta-blockers decreased the heart rate and LVOT pressure gradient during DSE, and simultaneously improved or eliminated their cardiac symptoms such as chest pain or dyspnea.…”

Section: Discussionmentioning

confidence: 64%

“…Recent reports have indicated that LVOT obstructions become apparent during a dobutamine infusion or exercise testing in 25-50% of patients with non-obstructive hypertrophic cardiomyopathy (HCM) [7,[14][15][16]. There have also been several case reports about such latent LVOT obstructions in persons with an SVS [4,5], but its actual prevalence is unclear. In the present prospective study, 62.5% of the SVS group developed LVOT obstructions during the DSE.…”

Section: Lvot Obstructions During Dsementioning

confidence: 99%

“…A sigmoid ventricular septum (SVS) is considered to be related to the normal aging process and has not been reported to be associated with an adverse prognosis [1][2][3]. However, a left ventricular outflow tract (LVOT) obstruction can occur in persons with an SVS [4,5]. According to one report, about 50% of persons with an SVS have an excessive response to dobutamine and develop an LVOT obstruction even in the absence of regional left ventricular wall motion abnormalities, i.e.…”

Section: Introductionmentioning

confidence: 99%

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Major determinants and possible mechanism of dobutamine-induced left ventricular outflow tract obstruction in patients with a sigmoid ventricular septum

Tano

Kasamaki

Okumura

et al. 2013

Journal of Cardiology

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Section: Discussionmentioning

confidence: 64%

Section: Lvot Obstructions During Dsementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Major determinants and possible mechanism of dobutamine-induced left ventricular outflow tract obstruction in patients with a sigmoid ventricular septum

Tano

Kasamaki

Okumura

et al. 2013

Journal of Cardiology

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“…24,52 Hypotension It may result from 1) An inadequate increase in cardiac output to compensate for an expected decrease in systemic vascular resistance, 53,54…”

Section: Mitral Regurgitationmentioning

confidence: 99%

Safety and Diagnostic Accuracy of Dobutamine Stress Echocardiography

Shah

2017

Nepalese Heart J.

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Exercise and pharmacologic stress echocardiography has been used routinely in clinical practice for the past twenty to thirty years. Dobutamine stress echocardiography (DSE) is well established as a safe, feasible, and accurate modality for detection of myocardial ischemia and prognostication in patients with known or suspected coronary artery disease, particularly when they have limited exercise capacity. Serious side effects during or shortly after DSE are uncommon, with ventricular fibrillation or myocardial infarction occurring in approximately 1 of 2,000 studies. No deaths have been reported. On the basis of a total number of 2,246 patients, reported in 28 studies, the sensitivity, specificity and accuracy of the test for the detection of coronary artery disease (CAD) were 80%, 84% and 81%, respectively. Mean sensitivities for one, two and three-vessel disease were 74%, 86% and 92%, respectively. The sensitivity of detection of disease in the let circumflex coronary artery (55%) was lower, both compared with that for left anterior descending (72%) and right coronary artery disease (76%). The sensitivity of predicting multivessel disease by multiregional echocardiographic abnormalities varied widely, from 8% to 71%. In direct comparisons, DSE was superior to exercise electrocardiography and dipyridamole echocardiography and comparable to exercise echocardiography and radionuclide imaging. DSE is useful, feasible and safe exercise independent stress modality for assessing the presence, localization and extent of CAD.

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“…However, not every patient with dynamic LVOT obstruction has HCM. Some other structural or functional features of the LV may play important roles in the development of LVOT obstruction ( 8 , 9 ). Indeed, patients with TCM complicated by LVOT obstruction have been reported to frequently present a sigmoid septum ( 10 ).…”

Section: Discussionmentioning

confidence: 99%

Takotsubo Cardiomyopathy in a Patient with Previously Undiagnosed Hypertrophic Cardiomyopathy with Latent Obstruction

et al. 2018

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A 62-year-old woman with takotsubo cardiomyopathy (TCM) accompanied by cardiogenic shock due to the obstruction of left ventricular outflow tract (LVOT) and massive mitral regurgitation (MR) was admitted to the emergency department. After successful treatment with intensive care, dobutamine stress-echocardiography was performed, which reproduced a dynamic LVOT gradient, severe MR and cardiogenic shock. A histological examination obtained from the right ventricular septum demonstrated hypertrophied and bizarre myocytes, with myocyte disarray. Besides TCM, a diagnosis of preexisting hypertrophic cardiomyopathy with latent obstruction was made. She was discharged with medical therapy including a beta-blocker, which would not be routinely employed in the treatment of a patient with TCM.

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Dobutamine Stress Echocardiography Unmasks Acute Worsening of Mitral Regurgitation with Latent Left Ventricular Outflow Tract Obstruction Behind Diastolic Heart Failure in Hypertensive Heart Disease

Abstract: In a 57-year-old

Cited by 6 publications

References 16 publications

Major determinants and possible mechanism of dobutamine-induced left ventricular outflow tract obstruction in patients with a sigmoid ventricular septum

Major determinants and possible mechanism of dobutamine-induced left ventricular outflow tract obstruction in patients with a sigmoid ventricular septum

Safety and Diagnostic Accuracy of Dobutamine Stress Echocardiography

Takotsubo Cardiomyopathy in a Patient with Previously Undiagnosed Hypertrophic Cardiomyopathy with Latent Obstruction

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