Doppler echocardiography underestimates the prevalence and magnitude of mid‐cavity obstruction in patients with symptomatic hypertrophic cardiomyopathy

Doppler echocardiography underestimates the prevalence and magnitude of mid‐cavity obstruction... INTRODUCTIONHypertrophic cardiomyopathy (HCM)HCM is the commonest familial heart disease, with a prevalence of up to 0.2% . HCM is characterized by left ventricular hypertrophy (LVH) in the absence of another disease process accounting for the magnitude of hypertrophy present . Many patients remain asymptomatic for decades; however, patients may present with cardiac arrhythmias or with debilitating symptoms including chest pain, dyspnea, dizziness, and fatigue . Obstruction to LV systolic ejection is frequently detected in patients with symptomatic HCM and contributes to symptoms and prognosis. As such, the presence and magnitude of obstruction dominates clinical decision making .In the “classical” variant of obstructive HCM, the closed mitral valve progressively moves toward the hypertrophied interventricular septum in systole [systolic anterior motion (SAM)]. This results in a dynamic LV outflow tract obstruction (LVOTO) and secondary mitral regurgitation. In a less common obstructive HCM variant (up to 10% in some series) , dynamic intracavity obstruction develops as a consequence of hypertrophy and apparent hypercontractility at the level of the papillary muscles causing LV mid‐cavity obstruction (LVMCO) .LVMCO is not associated with mitral regurgitation or SAM and is often missed at echocardiography, the distal chamber being outside the sector of two‐dimensional imaging due to http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Catheterization and Cardiovascular Interventions Wiley

Doppler echocardiography underestimates the prevalence and magnitude of mid‐cavity obstruction in patients with symptomatic hypertrophic cardiomyopathy

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Publisher
Wiley Subscription Services, Inc., A Wiley Company
Copyright
© 2018 Wiley Periodicals, Inc.
ISSN
1522-1946
eISSN
1522-726X
D.O.I.
10.1002/ccd.27143
Publisher site
See Article on Publisher Site

Abstract

INTRODUCTIONHypertrophic cardiomyopathy (HCM)HCM is the commonest familial heart disease, with a prevalence of up to 0.2% . HCM is characterized by left ventricular hypertrophy (LVH) in the absence of another disease process accounting for the magnitude of hypertrophy present . Many patients remain asymptomatic for decades; however, patients may present with cardiac arrhythmias or with debilitating symptoms including chest pain, dyspnea, dizziness, and fatigue . Obstruction to LV systolic ejection is frequently detected in patients with symptomatic HCM and contributes to symptoms and prognosis. As such, the presence and magnitude of obstruction dominates clinical decision making .In the “classical” variant of obstructive HCM, the closed mitral valve progressively moves toward the hypertrophied interventricular septum in systole [systolic anterior motion (SAM)]. This results in a dynamic LV outflow tract obstruction (LVOTO) and secondary mitral regurgitation. In a less common obstructive HCM variant (up to 10% in some series) , dynamic intracavity obstruction develops as a consequence of hypertrophy and apparent hypercontractility at the level of the papillary muscles causing LV mid‐cavity obstruction (LVMCO) .LVMCO is not associated with mitral regurgitation or SAM and is often missed at echocardiography, the distal chamber being outside the sector of two‐dimensional imaging due to

Journal

Catheterization and Cardiovascular InterventionsWiley

Published: Jan 1, 2018

Keywords: ; ; ;

References

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