Standing and Exercise Doppler Echocardiography in Obstructive Hypertrophic Cardiomyopathy: The Range of Gradients with Upright Activity

Decreased carotid and vertebral arterial blood-flow velocity in response to orthostatic unload in patients with severe aortic stenosis

“…Several studies have reported the importance of upright positioning during exercise in the detection of provocable (latent) or labile left ventricular (LV) outflow tract gradients in hypertrophic cardiomyopathy [3][4][5][6][7][8][9][10][11][12]. Also, passive orthostatic tests (without exercise) are helpful in diagnostic evaluation in other diseases predisposing to LV outflow tract gradients [8,12].…”

O diagnóstico da obstrução da via de saída do ventrículo esquerdo na cardiomiopatia hipertrófica

“…In a later study, the peak of exercise gradient was demonstrated to present correlation with that on the supine recovery phase, and that the early development of obstruction was associated to higher reduction of function capacity 46 . In other set of cases, although elevation of gradient in 76% of the patients in standing position has been observed, a higher increment was found in exertion, in measurements made in supine recovery phase 40 .…”

“…Figures 2A and B), but it underestimates the presence or magnitude of the exercise-induced gradient with sensitivity of only 40% for identifying the obstruction 27 . However, it is more sensitive than measurements in standing position 40 . In a series of patients submitted to percutaneous alcohol septal ablation, but, even though its application is arguable for recording purposes 41 , the Valsalva maneuver and the exercise were found to produce similar degrees of elevation of the gradient in outflow tract 42 .…”

“…Technical difficulties in obtaining the images can be minimized by greater operator's training and positioning of the patient's left arm on the head 40 , or through the use of transducers with continuous hands-free recording 47 .…”

Imaging in hypertrophic cardiomyopathy. Expert consensus statement of the Polish Clinical Forum for Cardiovascular Imaging

“…Jeżeli chory pozostaje bezobjawowy, badanie (2D + dopler) należy powtórzyć po roku, w przypadku objawów konieczne jest wykonanie wysiłkowego badania echokardiograficznego. Prowokowany wysiłkiem wzrost gradientu w LVOT (≥ 50 mm Hg) nakazuje rozważenie wskazań do terapii zmniejszającej hemodynamiczne skutki zawężania (miektomia, ablacja alkoholowa), jeżeli optymalna farmakoterapia nie jest skuteczna [43][44][45][46][47]. Najnowsze zalecenia ESC [2] nie standaryzują echa wysiłkowego, pozostawiając sposób jego wykonania do uznania doświadczonego zespołu badawczego, zgodnie z wypracowanym sposobem postępowania.…”