Diagnosis of Latent Hypertrophic Obstructive Cardiomyopathy with Dobutamine Stress Echocardiography

Kwon Sam Kim; Hyo Jung Lee; Mu Youl Lee; Heung Sun Kang; Chung Whee Cho; Myung Shick Kim; Jung Sang Song; Jong Hoa Bae

doi:10.3803/jkes.1996.4.1.29

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Kim, Lee, Lee, Kang, Cho, Kim, Song, and Bae: Diagnosis of Latent Hypertrophic Obstructive Cardiomyopathy with Dobutamine Stress Echocardiography

Original Article

J Korean Soc Echocardiogr 1996;4(1):29-33.

Published online: 18 February 1996

DOI: https://doi.org/10.3803/jkes.1996.4.1.29

Diagnosis of Latent Hypertrophic Obstructive Cardiomyopathy with Dobutamine Stress Echocardiography

Kwon Sam Kim, M.D., Hyo Jung Lee, M.D., Mu Youl Lee, M.D., Heung Sun Kang, M.D., Chung Whee Cho, M.D., Myung Shick Kim, M.D., Jung Sang Song, M.D., Jong Hoa Bae, M.D.

Division of Cardiology, Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

In latent type of hypertrophic obstructive cardiomyopathy, there is no pressure gradient at rest in left ventricular outflow tract(LVOT), but it develops with provocation. Dobutamine increase myocardial contractility and may induce outflow tract obstruction. To evaluate the usefulness of dobutamine induced outflow tract obstruction as a provocation test, nine patients with latent obstructive cardiomyopathy were studied.

Method

680 cases of dobutamine stress echocardiography were reviewed. Nine patients developed late peaking outflow velocity pattern in response to dobutamine infusion (inducible group). Ten patients developed early peaking velocity pattern were included as control group. Left ventricular dimension, outflow tract diameter were measured, and pattern of septal hypertrophy was classified. Changes of peak velocity and acceleration time/ejection time ratio (AT/ET) were measured at rest and peak dose dobutamine.

Results

The peak outflow velocity at rest was not different in both groups (1.49 ± 0.45, 1.18 ± 0.11m/sec). Peak velocity and AT/ET ratio were significantly increased in inducible group (4.2 ± 0.9m/sec, 0.66 ± 0.17), but no significant changes were noted in control group. Patients with inducible group had greater septal thickness, smaller outflow tract diameter and greater prevalence of septal bulge morphology.

Conclusion

These results suggest that dobutamine stress Doppler echocardiography could be a useful provocation test to diagnosis of latent obstructive cardiomyopathy.

Keywords: Dobutamine stress echocardiography, Latent obstructive cardiomyopathy.

References

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Fig. 1.

Continious wave Doppler echocardiographic signals from LVOT at rest(left) and dobutamine infusion(right) in a patient with inducible group. Peak velocity of outflow tract jet increased from 1.3m/sec to 4.5m/sec in response to dobutamine.

Fig. 2.

Change of velocity and AT/ET ratio of outflow tract ject at rest and dobutamine infusion with continous wave Doppler echocardiography.

Table 1.

Clinical and echocardiographic results of study patients

	Inducible group	Control group
Age	60 ± 5	56 ± 7
Male/Femle	6/3	6/4
Hypertension	3	0
Septal thickness(cm)	1.7 ± 0.2^†	1.1 ± 0.2
Posterior wall thickness(cm)	1.1 ± 0.1^†	0.9 ± 0.1
LVED(cm)	4.1 ± 0.5^∗	4.8 ± 0.7
LVES(cm)	2.7 ± 0.4^∗	3.4 ± 0.9
LVOT diameter(mm)	1.2 ± 0.2^†	1.6 ± 0.2
Septal hypertrophy
Basal 1/3∼2/3	5	-
Entire	4	-
SAM	3	-

^† :p<0.001

^∗ p<0.05

ED: End Diastole ES: End Systole

LVOT: Left Ventricular Outflow Tract

SAM: Systolic Anterior Motion

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