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Prevalence of Exercise Induced Left Ventricular Outflow Tract Obstruction in Symptomatic Patients with Non-obstructive Hypertrophic Cardiomyopathy
  1. Jaymin S Shah (jbidd{at}onetel.com)
  1. The Heart Hospital, UCLH, London, United Kingdom
    1. Maria Teresa Tome Esteban (maite.tome{at}uclh.org)
    1. Great Ormond Street / The Heart Hospital, United Kingdom
      1. Rajesh Thaman (rthaman_{at}hotmail.com)
      1. The Heart Hospital, UCLH, London, United Kingdom
        1. Rajan Sharma (rajan.sharma{at}uclh.org)
        1. The Heart Hospital, UCLH, London, United Kingdom
          1. Bryan Mist (brian.mist{at}uclh.org)
          1. The Heart Hospital, UCLH, London, United Kingdom
            1. Antonis Pantazis (antonis.pantazis{at}uclh.org)
            1. The Heart Hospital, UCLH, London, United Kingdom
              1. Deirdre Ward (deirdre.ward{at}uclh.org)
              1. The Heart Hospital, UCLH, London, United Kingdom
                1. Sanjay K Kohli (sanjay.kohli{at}uclh.org)
                1. The Heart Hospital, UCLH, London, United Kingdom
                  1. Steve P Page (steve.page{at}uclh.org)
                  1. The Heart Hospital, UCLH, London, United Kingdom
                    1. Camelia Demetrescu (camelia.demetrescu{at}uclh.org)
                    1. The Heart Hospital, UCLH, London, United Kingdom
                      1. Elias Sevdalis (sevdalis{at}otenet.gr)
                      1. The Heart Hospital, UCLH, London, United Kingdom
                        1. Andre Keren (andrek{at}cc.huji.ac.il)
                        1. Bikur Cholim Hospital, Jerusalem, Israel
                          1. Denis Pellerin (denis.pellerin{at}uclh.org)
                          1. The Heart Hospital, UCLH, London, United Kingdom
                            1. William J McKenna (william.mckenna{at}uclh.org)
                            1. University College London, United Kingdom
                              1. Perry M Elliott (perry.elliott{at}doctors.org.uk)
                              1. The Heart Hospital, UCLH, London, United Kingdom

                                Abstract

                                Background Resting left ventricular outflow tract obstruction (LVOTO) occurs in 25% of patients with hypertrophic cardiomyopathy (HCM) and is an important cause of symptoms and disease progression. The prevalence and clinical significance of exercise induced LVOTO in patients with symptomatic non-obstructive HCM is uncertain.

                                Methods & results 87 symptomatic patients (43.3 ± 13.7 years, 67.8% males) with HCM without previously documented LVOTO (defined as a gradient ≥ 30mmHg) underwent echocardiography during upright cardiopulmonary exercise testing: 54 (62.1%; 95% CI = 51.5, 71.6) patients developed LVOTO during exercise (latent LVOTO); 33 (37.9%; ; 95% CI = 28.4, 48.5) had neither resting nor exercise LVOTO (non-obstructive). Patients with latent LVOTO were more likely to have SAM at rest (relative risk 2.1, 95% CI=1.2, 3.8; p = 0.01), and higher peak oxygen consumption (mean difference: 10.3%, 95% CI = 2.1, 18.5; p = 0.02) than non-obstructive patients. The only independent predictors of Δ gradient during exercise were a history of presyncope/syncope, incomplete/complete SAM at rest and Wigle score (all p < 0.05). Subsequent invasive reduction of LVOTO in 10 patients with drug refractory symptoms resulted in improved functional class and less syncope/presyncope (all p < 0.05)

                                Conclusions Approximately two thirds of patients with symptomatic non-obstructive HCM have latent LVOTO. This study suggests that all patients with symptomatic non-obstructive HCM should have exercise stress echocardiography.

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