title: Relationship between outflow obstruction and left ventricular functional impairment in hypertrophic cardiomyopathy: a Doppler echocardiographic study.
abstract: Left ventricular outflow tract (LVOT) obstruction is predictive of a worse outcome in hypertrophic cardiomyopathy (HCM). In a detailed Doppler echocardiographic study of 178 selected HCM patients, the group of patients (n = 73) with the obstructive form (resting peak gradient > or = 30 mmHg) presented more hypertrophy and poorer systolic and diastolic left ventricular (LV) functions than the HCM group (n = 105) without obstruction. LVOT peak gradient was positively correlated with hypertrophy (P < 0.0001) and negatively to tissue Doppler mitral annulus systolic (P = 0.0001) and early diastolic (P < 0.0001) velocities. The gradient significantly correlated with E/Ea ratio (r = 0.67; P < 0.0001). By multiple regression, LVOT gradient was related to E/Ea, LV maximal thickness and left atrial size. In comparison with patients without obstruction, patients with obstruction presented greater hypertrophy (P < 0.0001), lower systolic and early diastolic mitral annulus velocities (both P < 0.0001), higher E/Ea ratio (P < 0.0001) and higher global function index (P < 0.0001). In HCM, beyond the effects on hypertrophy, LVOT obstruction is an independent determinant of LV functional abnormalities.
authors.affiliation: Cardiomyopathies Division-Heart Institute (InCor), University of São Paulo Medical School, Av. Eneas Carvalho Aguiar 44, 05403-900 São Paulo, SP, Brazil. aloirqueiroz@cardiol.br
authors.forename: Aloir Q
authors.initials: AQ
authors.lastname: Araujo
authors.forename: Edmundo
authors.initials: E
authors.lastname: Arteaga
authors.forename: Barbara M
authors.initials: BM
authors.lastname: Ianni
authors.forename: Fabio
authors.initials: F
authors.lastname: Fernandes
authors.forename: Felix J
authors.initials: FJ
authors.lastname: Ramires
authors.forename: Paula C
authors.initials: PC
authors.lastname: Buck
authors.forename: Vera M C
authors.initials: VM
authors.lastname: Salemi
authors.forename: Luciano
authors.initials: L
authors.lastname: Nastari
authors.forename: Charles
authors.initials: C
authors.lastname: Mady
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D001938:Brazil; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology*; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D015999:Multivariate Analysis; D009200:Myocardial Contraction; D011237:Predictive Value of Tests; D012107:Research Design; D012720:Severity of Illness Index; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology*; D016277:Ventricular Function, Left; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology*