title: Diverse geometric changes related to dynamic left ventricular outflow tract obstruction without overt hypertrophic cardiomyopathy.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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'.
  
  
  CONCLUSIONS
  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.
authors.forename: Jung-Joon
authors.initials: JJ
authors.lastname: Cha
authors.forename: Hyemoon
authors.initials: H
authors.lastname: Chung
authors.affiliation: Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. DRCLIFF@yuhs.ac.
authors.forename: Young Won
authors.initials: YW
authors.lastname: Yoon
authors.forename: Ji Hyun
authors.initials: JH
authors.lastname: Yoon
authors.forename: Jong-Youn
authors.initials: JY
authors.lastname: Kim
authors.forename: Pil-Ki
authors.initials: PK
authors.lastname: Min
authors.forename: Byoung-Kwon
authors.initials: BK
authors.lastname: Lee
authors.forename: Bum-Kee
authors.initials: BK
authors.lastname: Hong
authors.forename: Se-Joong
authors.initials: SJ
authors.lastname: Rim
authors.forename: Hyuck Moon
authors.initials: HM
authors.lastname: Kwon
authors.forename: Eui-Young
authors.initials: EY
authors.lastname: Choi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010210:Papillary Muscles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D012189:Retrospective Studies; D013599:Systole / Q000502:physiology; D014463:Ultrasonography; D014636:Valsalva Maneuver / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging* / Q000503:physiopathology; D017725:Ventricular Pressure / Q000502:physiology