Article Text

Download PDFPDF
Heart failure and cardiomyopathy
Steep left ventricle to aortic root angle and hypertrophic obstructive cardiomyopathy: study of a novel association using three-dimensional multimodality imaging
  1. D H Kwon1,
  2. N G Smedira1,
  3. Z B Popovic1,
  4. B W Lytle1,
  5. R M Setser2,
  6. M Thamilarasan1,
  7. P Schoenhagen1,2,
  8. S D Flamm1,2,
  9. H M Lever1,
  10. M Y Desai1,2
  1. 1
    Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
  2. 2
    Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Dr M Y Desai, Department of Cardiovascular Medicine, Heart and Vascular Institute, Desk J1-5, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; desaim2{at}


Background: Patients with hypertrophic cardiomyopathy (HCM) exhibit a difference in left ventricular outflow tract (LVOT) obstruction, independently of basal septal thickness (BST). Some patients with HCM have a steeper left ventricle to aortic root angle than controls.

Objective: To test the predictors of the LV-aortic root angle and the association between LV-aortic root angle and LVOT obstruction using three-dimensional imaging.

Patients: 153 consecutive patients with HCM (mean (SD) age 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) who underwent whole-heart three-dimensional cardiac magnetic resonance (CMR) angiography (1.5 T) and Doppler echocardiography. Forty-two controls (age 43 (11) years, 38% men) who underwent contrast-enhanced multidetector computed tomography and were free of cardiovascular pathology were also studied.

Main outcomes: LV-aortic root angle, BST and maximal non-exercise LVOT gradient were measured in patients with HCM and in hypertensive-elderly patients. Additionally, LV-aortic root angle and BST were measured in controls.

Results: The mean (SD) LV-aortic root angle was significantly different (p<0.001) in the three groups: HCM (134 (10)°), hypertensive-elderly (128 (10)°), control (140 (7)°). There was an inverse correlation between age and LV-aortic root angle in the three groups (all p<0.001): HCM (r = −0.56), hypertensive-elderly (r = −0.35), control (r = −0.48). On univariate analysis, in the HCM group, LV-aortic root angle (β = −0.34, p<0.001), age (β = 0.23, p = 0.01) and end-systolic volume index (β = −0.20, p = 0.02), but not BST (β = 0.02, p = 0.8), were associated with LVOT gradient. On multivariate analysis, only LV-aortic root angle was associated with LVOT gradient.

Conclusions: Patients with HCM have a steeper LV-aortic root angle than controls. In patients with HCM, a steeper LV-aortic root angle predicts dynamic LVOT obstruction, independently of BST.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • See Editorial, page 1725

  • Competing interests None declared.

  • Ethics approval Approved by the Cleveland Clinic IRB.

  • Provenance and Peer review Not commissioned; externally peer reviewed.

Linked Articles