Labil subaortic obstruction during exercise stress echocardiography

Peteiro, Jesús; Montserrat, Lorenzo; Castro‐Beiras, Alfonso

doi:10.1016/s0002-9149(99)00517-2

Cited by 31 publications

(16 citation statements)

References 9 publications

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“…This distinction also suggests that basal septal hypertrophy is less likely to be a subtype of HCM. Another interesting finding is lots of patients had SAM or chordal SAM in this population, which is consistent with previous observation [15]. Therfore LV geometric change in combination with abnormal mitral apparatus abnormalities such as systolic movement of mitral leaflets, chordae and papillary muscle may contribute developments of DLVOTO [16,17].…”

Section: Discussionsupporting

confidence: 91%

Diverse geometric changes related to dynamic left ventricular outflow tract obstruction without overt hypertrophic cardiomyopathy

Cha

Chung

Yoon

et al. 2014

Cardiovasc Ultrasound

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BackgroundDynamic left ventricular (LV) outflow tract (LVOT) obstruction (DLVOTO) is not infrequently observed in older individuals without overt hypertrophic cardiomyopathy (HCM). We sought to investigate associated geometric changes and then evaluate their clinical characteristics.MethodsA total of 168 patients with DLVOTO, which was defined as a trans-LVOT peak pressure gradient (PG) higher than 30 mmHg at rest or provoked by Valsalva maneuver (latent LVOTO) without fixed stenosis, were studied. Patients with classical HCM, acute myocardial infarction, stress induced cardiomyopathy or unstable hemodynamics which potentially induce transient-DLVOTO were excluded.ResultsTheir mean age was 71 ± 11 years and 98 (58%) patients were women. Patients were classified as pure sigmoid septum (n = 14) if they have basal septal bulging but diastolic thickness less than 15 mm, sigmoid septum with basal septal hypertrophy for a thickness ≥15 mm (n = 85), prominent papillary muscle (PM) (n = 20) defined by visually large PMs which occluded the LV cavity during systole or 1/2 LVESD, or as having a small LV cavity with concentric remodelling or hypertrophy (n = 49). The prominent PM group was younger, had a higher S’ and lower E/e’ than other groups. In all groups, a higher peak trans-LVOT PG was related (p < 0.10) to higher E/e’, systolic blood pressure, relative wall thickness, and pulmonary arterial systolic pressure. In multivariate analysis, resting trans-LVOT PG correlated to pulmonary arterial pressure (ß = 0.226, p = 0.019) after adjustment for systolic blood pressure, relative wall thickness, and E/e’.ConclusionsDLVOTO develops from various reasons, and patients with prominent PMs have distinct characteristics. We suggest to use DLVOTO-relieving medication might reduce pulmonary pressure in this group of patients.

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Section: Discussionsupporting

confidence: 91%

Diverse geometric changes related to dynamic left ventricular outflow tract obstruction without overt hypertrophic cardiomyopathy

Cha

Chung

Yoon

et al. 2014

Cardiovasc Ultrasound

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“…The condition of DLVOTO in the absence of hypertrophic obstructive cardiomyopathy (HCM) has been previously described in stress echocardiography (dobutamine [4][5][6][7][8][9][10][11][12][13] and exercise [14]), following aortic [15][16][17] or mitral valve replacement [18][19][20][21][22][23], and in acute coronary syndromes [24,25].…”

Section: Introductionmentioning

confidence: 99%

Beta-blocker therapy for dynamic left ventricular outflow tract obstruction induced by exercise

Cabrera-Bueno

García‐Pinilla

Gómez‐Doblas

et al. 2007

International Journal of Cardiology

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“…The development of intra-ventricular gradients (IVG) during exercise is rare, and it usually occurs in association with left ventricular hypertrophy [41,42]. The development of significant IVG during exercise has been anecdotically described in athletes [43-45], but the clinical impact of this observation and the most appropriate exercise technique (upright vs. semi supine) to provoke IVG remains unknown.…”

Section: Introductionmentioning

confidence: 99%

“…The occurrence of IVG during exercise stress echocardiography is rarely found [41]. In a group of 10 patients who developed IVG during dobutamine stress echocardiography, we performed exercise stress echocardiography and we found a small magnitude IVG in only one of them [65].…”

Section: Introductionmentioning

confidence: 99%

“…The results of our study, in which 36% of the patients with normal coronary angiogram and positive treadmill exercise test developed significant intra-ventricular gradients, suggest that ST-segment depression may be related with the development of IVG during exercise, which is possibly involved in the genesis of electrocardiographic changes. The possible association between cardiac X syndrome and IVG during exercise was described before [57,58], however the inclusion of patients more prone to develop IVG such as hypertensive ones with left ventricular hypertrophy limits their findings [41]. …”

Section: Introductionmentioning

confidence: 99%

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Clinical applications of exercise stress echocardiography in the treadmill with upright evaluation during and after exercise

Cotrim

João

Fazendas

et al. 2013

Cardiovasc Ultrasound

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Exercise stress echocardiography is the most frequently used stress test in our laboratory. Exercise echocardiography is used mainly in the study of patients with coronary artery disease. However, the technique is increasingly being used to study other diseases.In our centre, we use an original methodology, published by us in 2000, in which we evaluate heart function during exercise in the treadmill. After the exercise, patients are maintained in orthostatic position when appropriate or lying down in left lateral decubitus for further evaluation. Since this method seems to increase the quality and the quantity of information obtained in so many clinical arenas, we now present a detailed review of this methodology and its applications.

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Labil subaortic obstruction during exercise stress echocardiography

Cited by 31 publications

References 9 publications

Diverse geometric changes related to dynamic left ventricular outflow tract obstruction without overt hypertrophic cardiomyopathy

Diverse geometric changes related to dynamic left ventricular outflow tract obstruction without overt hypertrophic cardiomyopathy

Beta-blocker therapy for dynamic left ventricular outflow tract obstruction induced by exercise

Clinical applications of exercise stress echocardiography in the treadmill with upright evaluation during and after exercise

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