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

 Jung-Joon Cha  ;  Hyemoon Chung  ;  Young Won Yoon  ;  Ji Hyun Yoon  ;  Jong-Youn Kim  ;  Pil-Ki Min  ;  Byoung-Kwon Lee  ;  Bum-Kee Hong  ;  Se-Joong Rim  ;  Hyuck Moon Kwon  ;  Eui-Young Choi 
 Cardiovascular Ultrasound, Vol.12(23) : 1-8, 2014 
Journal Title
 Cardiovascular Ultrasound 
Issue Date
BACKGROUND: Dynamic 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. METHODS: A 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. RESULTS: Their 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'. CONCLUSIONS: DLVOTO 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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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
권혁문(Kwon, Hyuck Moon) ORCID logo https://orcid.org/0000-0001-9901-5015
김종윤(Kim, Jong Youn) ORCID logo https://orcid.org/0000-0001-7040-8771
민필기(Min, Pil Ki) ORCID logo https://orcid.org/0000-0001-7033-7651
윤영원(Yoon, Young Won) ORCID logo https://orcid.org/0000-0002-0907-0350
윤지현(Yoon, Ji Hyun)
이병권(Lee, Byoung Kwon) ORCID logo https://orcid.org/0000-0001-9259-2776
임세중(Rim, Se Joong) ORCID logo https://orcid.org/0000-0002-7631-5581
정혜문(Chung, Hye Moon)
차정준(Cha, Jung-Joon) ORCID logo https://orcid.org/0000-0002-8299-1877
최의영(Choi, Eui Young) ORCID logo https://orcid.org/0000-0003-3732-0190
홍범기(Hong, Bum Kee) ORCID logo https://orcid.org/0000-0002-6456-0184
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