Cha Jung-Joon, Chung Hyemoon, Yoon Young Won, Yoon Ji Hyun, Kim Jong-Youn, Min Pil-Ki, Lee Byoung-Kwon, Hong Bum-Kee, Rim Se-Joong, Kwon Hyuck Moon, Choi Eui-Young
Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Cardiovasc Ultrasound. 2014 Jul 3;12:23. doi: 10.1186/1476-7120-12-23.
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.
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.
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'.
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.
动态左心室（LV）流出道（LVOT）梗阻（DLVOTO）在无明显肥厚型心肌病（HCM）的老年个体中并不少见。我们试图研究相关的几何变化，然后评估其临床特征。
共研究了168例DLVOTO患者，其定义为静息时或通过瓦尔萨尔瓦动作诱发（潜在LVOTO）时经LVOT的峰值压力梯度（PG）高于30 mmHg且无固定狭窄。排除患有经典HCM、急性心肌梗死、应激性心肌病或不稳定血流动力学（可能诱发短暂性DLVOTO）的患者。
他们的平均年龄为71±11岁，98例（58%）为女性。如果患者有基底间隔膨出但舒张期厚度小于15 mm，则分类为单纯乙状结肠样间隔（n = 14）；乙状结肠样间隔伴基底间隔肥厚，厚度≥15 mm（n = 85）；突出乳头肌（PM）（n = 20），定义为在收缩期视觉上较大的PM阻塞LV腔或为1/2左心室舒张末期内径（LVESD）；或为具有同心重构或肥厚的小LV腔（n = 49）。突出PM组比其他组更年轻，S'更高，E/e'更低。在所有组中，更高的经LVOT峰值PG与更高的E/e'、收缩压、相对壁厚度和肺动脉收缩压相关（p < 0.10）。多变量分析显示，在调整收缩压、相对壁厚度和E/e'后，静息时经LVOT PG与肺动脉压相关（β = 0.226，p = 0.019）。
DLVOTO由多种原因引起，突出PM的患者具有独特特征。我们建议使用缓解DLVOTO的药物可能会降低该组患者的肺动脉压力。
