Objective: Hypertrophic cardiomyopathy (HCM) patients exhibit difference in left ventricular outflow tract obstruction (LVOTO), independent of basal septal thickness (BST). We observed that some HCM patients have a steeper LV to aortic root angle (LVARA), as compared to controls. Using 3-dimensional imaging, we tested the predictors of LVARA and association between LVARA and LVOTO.
Patients: We studied 153 consecutive HCM patients (46±14 years, 68% men) and 62 patients with hypertensive heart disease of the elderly (all > 65 years of age, 73±6 years, 34% men) that underwent whole-heart 3D cardiac magnetic resonance (CMR) angiogram (1.5T Siemens) and Doppler echocardiography. We also studied 42 controls (43±11 years, 38 % men) that underwent contrast-enhanced multi-detector computed tomography (MDCT) and were free of cardiovascular pathology.
Main outcomes: LVARA, BST and maximal non-exercise LVOT gradient were measured in HCM and hypertensive-elderly patients. In addition, LVARA and BST were measured in controls.
Results: The mean LVARA was significantly different (p< 0.001) in 3 groups as follows: HCM (1340±10), hypertensive-elderly (1280±10) and control (1400±7). There was an inverse correlation between age and LVARA in the 3 groups (all p<0.001): HCM (r=-0.56), hypertensive-elderly (r=-0.35) and control (r=-0.48). On univariate analysis, in the HCM group, LVARA (beta=-0.34, p-value<0.001), age (beta=0.23, p-value=0.01) and end-systolic volume index (beta=-0.20, p-value=0.02); but not BST (beta=0.02, p=0.8), were associated with LVOT gradient. On multivariate analysis, only LVARA was associated with LVOT gradient.
Conclusions: HCM patients have a steeper LVARA, compared to controls. In HCM patients, steeper LVARA predicts dynamic LVOTO, independent of BST.
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