[The provocation of dynamic obstruction of the left ventricular outflow tract in secondary myocardial hypertrophy].
The effect of the Valsalva manoeuvre before and after sublingual administration of 1.6 mg nitroglycerin on maximal velocity (Vmax), acceleration time (AT) and ejection time (ET) of left-ventricular outflow was measured by Doppler echocardiography in 49 patients (28 men and 21 women; mean age 65 [48-84] years) with secondary left-heart hypertrophy, and in 8 controls. Changes in flow profile typical of dynamic obstruction in the left-ventricular outflow tract (LVOT) occurred in 30 of the patients, Vmax increasing from a mean of 137 to 302 cm/s. Latent LVOT obstruction was associated with a thickened posterior wall, an accelerated left-ventricular outflow even at rest and systolic anterior motion of the anterior mitral leaflet (SAM phenomenon). The size of the provoked LVOT gradient correlated significantly with Vmax or the AT/ET ratio at rest. Obstruction of the LVOT is apparently a non-specific phenomenon which also occurs in secondary left-heart hypertrophy. These findings may have therapeutic consequences.
Faber
L
L
Klinik Martinusquelle, Bad Lippspringe.
Klempt
H W
HW
Dumitriu
M
M
D000368:Aged; D000369:Aged, 80 and over; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D003971:Diastole / Q000187:drug effects / Q000502:physiology; D015150:Echocardiography, Doppler / Q000295:instrumentation; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin; D013599:Systole / Q000187:drug effects / Q000502:physiology; D014636:Valsalva Maneuver / Q000502:physiology; D016277:Ventricular Function, Left / Q000187:drug effects / Q000502:physiology*
D005996:Nitroglycerin
Provokation einer dynamischen Obstruktion des linksventrikulären Ausflusstrakts bei sekundärer Myokardhypertrophie.