[Functional maneuvers for the diagnosis of hypertrophic cardiomyopathies with and without left ventricular outflow obstruction].
OBJECTIVE
to assess the diagnostic value of the commonly adopted haemodynamic criteria for the diagnosis of obstructive and non-obstructive hypertrophic cardiomyopathy.


METHODS
16 cases of hypertrophic cardiomyopathy, 7 cases of the non-obstructive form, 16 fixed subaortic stenosis, 8 valvular aortic stenosis, and 7 cases of hypertensive heart disease.


METHODS
left and right heart catheterisation, with particular attention to the pressure gradient and to the aortic pulse pressure by means of simultaneous pressure recording from the left ventricle and aorta under basal conditions, after a ventricular premature beat, during the Valsalva manoeuvre, during amyl nitrite inhalation, and isoproterenol administration.


CONCLUSIONS
the Valsalva manoeuvre increases significantly (p < 0.001) the pressure gradient, and the aortic pulse pressure in the post-extrasystolic beat decreases significantly (p < 0.001) in patients with hypertrophic obstructive cardiomyopathy. This response is significantly different from that of the other 3 disease groups. If the non-obstructive form is defined by strict criteria (i.e. no gradient above 30 mmHg even after provocative manoeuvres), then it cannot be separated from other forms of secondary left ventricular hypertrophy.
Anselmino
M
M
Istituto di Medicina e Chirurgia Cardiovascolare, Università degli Studi, Torino.
Orzan
F
F
Bobbio
M
M
Fontana
V
V
Presbitero
P
P
Carini
G
G
Defilippi
G
G
Brusca
A
A
D000328:Adult; D000680:Amyl Nitrite; D006328:Cardiac Catheterization; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis* / Q000503:physiopathology; D003937:Diagnosis, Differential; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007545:Isoproterenol; D008297:Male; D008875:Middle Aged; D014636:Valsalva Maneuver / Q000187:drug effects / Q000502:physiology; D014694:Ventricular Outflow Obstruction / Q000175:diagnosis* / Q000503:physiopathology
D000680:Amyl Nitrite; D007545:Isoproterenol
Manovre funzionali per la diagnosi delle cardiomiopatie ipertrofiche con e senza ostruzione del tratto di efflusso del ventricolo sinistro.