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Three-Dimensional Echocardiographic Evaluation of Mitral Apparatus during Preload Manipulation in Patients with Hypertrophic Cardiomyopathy

 Hyemoon Chung  ;  Ji Hyun Yoon  ;  Young Won Yoon  ;  Ji Young Chung  ;  Jung-Joon Cha  ;  Jong-Youn Kim  ;  Pil-Ki Min  ;  Byoung-Kwon Lee  ;  Bum-Kee Hong  ;  Se-Joong Rim  ;  Hyuck Moon Kwon  ;  Eui-Young Choi 
 Echocardiography, Vol.32(8) : 1261-1269, 2015 
Journal Title
Issue Date
Adult ; Cardiomyopathy, Hypertrophic/complications ; Cardiomyopathy, Hypertrophic/diagnostic imaging* ; Cardiomyopathy, Hypertrophic/therapy* ; Echocardiography, Three-Dimensional/methods* ; Female ; Humans ; Image Enhancement/methods ; Image Interpretation, Computer-Assisted/methods ; Imaging, Three-Dimensional/methods ; Male ; Mitral Valve/diagnostic imaging* ; Reproducibility of Results ; Sensitivity and Specificity ; Ventricular Outflow Obstruction/diagnostic imaging* ; Ventricular Outflow Obstruction/etiology
hypertrophic cardiomyopathy ; three-dimensional echocardiography
BACKGROUND: The three-dimensional (3D) dynamic change of mitral geometry during preload manipulation has not been fully investigated. We investigated how preload manipulation affected the mitral apparatus geometry in hypertrophic cardiomyopathy (HCM) patients using 3D echocardiography. METHODS AND RESULTS: Twenty five HCM patients, thirteen with obstructive HCM (HOCM) and twelve with nonobstructive HCM (HNCM), and six healthy controls were studied. Subjects underwent 3D echocardiography during rest, leg raising, the Valsalva maneuver, and the Valsalva maneuver after nitroglycerin intake (NTG-Valsalva). Left ventricular outflow tract (LVOT) pressure gradients, mitral annular area, annular circumference, and the tenting volume of the mitral leaflets were measured. Standardized annular area significantly decreased during the NTG-Valsalva maneuver in all 3 groups (▵2.23 mm(2) /m(2) in control, P = 0.031; ▵0.46 mm(2) /m(2) in HNCM, P = 0.012; ▵1.3 mm(2) /m(2) in HOCM, P = 0.013). Standardized annular area decrease during the Valsalva maneuver alone was more prominent in HNCM patients (▵0.57 mm(2) /m(2) , P = 0.009) than HOCM patients (▵0.3 mm(2) /m(2) , P = 0.094). Standardized mitral tenting volume during the NTG-Valsalva maneuver significantly decreased only in HOCM patients (▵1.18 mm(3) /m(2) , P = 0.046). CONCLUSION: Decreased mitral annular area and changes in leaflets tenting volume during preload reduction might affect the development of LVOT obstruction. Our data suggest the importance of preserving the saddle-shaped of the mitral annulus in management of HCM with LVOT obstruction.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kwon, Hyuck Moon(권혁문) ORCID logo https://orcid.org/0000-0001-9901-5015
Kim, Jong Youn(김종윤) ORCID logo https://orcid.org/0000-0001-7040-8771
Min, Pil Ki(민필기) ORCID logo https://orcid.org/0000-0001-7033-7651
Yoon, Young Won(윤영원) ORCID logo https://orcid.org/0000-0002-0907-0350
Yoon, Ji Hyun(윤지현)
Lee, Byoung Kwon(이병권) ORCID logo https://orcid.org/0000-0001-9259-2776
Rim, Se Joong(임세중) ORCID logo https://orcid.org/0000-0002-7631-5581
Chung, Hye Moon(정혜문)
Cha, Jung-Joon(차정준) ORCID logo https://orcid.org/0000-0002-8299-1877
Choi, Eui Young(최의영) ORCID logo https://orcid.org/0000-0003-3732-0190
Hong, Bum Kee(홍범기) ORCID logo https://orcid.org/0000-0002-6456-0184
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