PMID- 20472917
OWN - NLM
STAT- MEDLINE
DCOM- 20110204
LR  - 20161125
IS  - 1532-2114 (Electronic)
IS  - 1532-2114 (Linking)
VI  - 11
IP  - 9
DP  - 2010 Oct
TI  - Comparison of Valsalva manoeuvre and exercise in echocardiographic evaluation of 
      left ventricular outflow tract obstruction in hypertrophic cardiomyopathy.
PG  - 763-9
LID - 10.1093/ejechocard/jeq063 [doi]
AB  - AIMS: Several methods are used to induce latent left ventricular outflow tract 
      (LVOT) gradients in patients with hypertrophic cardiomyopathy (HCM). We compared 
      LVOT gradients induced by Valsalva manoeuvre (VM) and exercise echocardiography 
      (EE) in patients with HCM treated with percutaneous transluminal septal 
      myocardial ablation (PTSMA). METHODS AND RESULTS: Left ventricular outflow tract 
      gradients were measured at rest, during VM, and during EE in 57 patients 3.8 +/- 
      2.8 years after PTSMA. Measurement succeeded in all patients during VM and in 96% 
      during EE. There were no differences in LVOT gradients between VM [17 (9-33) 
      mmHg] and EE [18 (10-30) mmHg, P = 0.31] [median (inter-quartile range)], but the 
      differences ranged from -45 to 84 mmHg in individual patients. In 93% of 
      patients, EE had no influence on the categorization into manifest-, latent- or 
      non-obstructive phenotypes. The 7%, who revealed LVOT gradients >/=30 mmHg only 
      during EE, did not reach LVOT gradients of 50 mmHg. Patients improving two New 
      York Heart Association (NYHA) classes after PTSMA had higher baseline LVOT 
      gradients during VM [115 (72-160) vs. 88 (54-114) mmHg, P = 0.04] and a larger 
      reduction in VM-induced LVOT gradients [80 (48-139) vs. 61 (28-83) mmHg, P = 
      0.02] than patients improving one NYHA class. CONCLUSION: Valsalva manoeuvre and 
      EE induce similar degrees of LVOT gradient, but categorization into obstructive 
      phenotypes was not influenced by EE in more than 90% of patients. Valsalva 
      manoeuvre should be the primary choice of stress modality in HCM patients treated 
      with PTSMA, but EE is essential for the clinical management of the entire cohort.
FAU - Jensen, Morten K
AU  - Jensen MK
AD  - Department of Cardiology, 2142 The Heart Centre, Rigshospitalet, University of 
      Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark. mortenjensen@dadlnet.dk
FAU - Havndrup, Ole
AU  - Havndrup O
FAU - Pecini, Redi
AU  - Pecini R
FAU - Dalsgaard, Morten
AU  - Dalsgaard M
FAU - Hassager, Christian
AU  - Hassager C
FAU - Helqvist, Steffen
AU  - Helqvist S
FAU - Kelbaek, Henning
AU  - Kelbaek H
FAU - Jorgensen, Erik
AU  - Jorgensen E
FAU - Kober, Lars
AU  - Kober L
FAU - Bundgaard, Henning
AU  - Bundgaard H
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20100515
PL  - England
TA  - Eur J Echocardiogr
JT  - European journal of echocardiography : the journal of the Working Group on 
      Echocardiography of the European Society of Cardiology
JID - 100890618
RN  - 0 (Contrast Media)
RN  - 0 (Polysaccharides)
RN  - 127279-08-7 (SHU 508)
SB  - IM
CIN - Eur J Echocardiogr. 2010 Oct;11(9):730; author reply 730-1. PMID: 20682578
MH  - Analysis of Variance
MH  - Cardiomyopathy, Hypertrophic/*diagnostic imaging/*physiopathology/surgery
MH  - Catheter Ablation/methods
MH  - Chi-Square Distribution
MH  - Cohort Studies
MH  - Contrast Media
MH  - Echocardiography, Doppler
MH  - Echocardiography, Stress/*methods
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Polysaccharides
MH  - Statistics, Nonparametric
MH  - Treatment Outcome
MH  - Ultrasonography, Interventional
MH  - *Valsalva Maneuver
MH  - Ventricular Outflow Obstruction/*diagnostic imaging/*physiopathology/surgery
EDAT- 2010/05/18 06:00
MHDA- 2011/02/05 06:00
CRDT- 2010/05/18 06:00
PHST- 2010/05/18 06:00 [entrez]
PHST- 2010/05/18 06:00 [pubmed]
PHST- 2011/02/05 06:00 [medline]
AID - jeq063 [pii]
AID - 10.1093/ejechocard/jeq063 [doi]
PST - ppublish
SO  - Eur J Echocardiogr. 2010 Oct;11(9):763-9. doi: 10.1093/ejechocard/jeq063. Epub 
      2010 May 15.