Impact of left ventricular outflow tract area on systolic outflow velocity in hypertrophic cardiomyopathy: A real-time three-dimensional echocardiographic study

Jian Xin Qin, Takahiro Shiota, Harry M. Lever, David N. Rubin, Fabrice Bauer, Yong-Jin Kim, Marta Sitges, Neil L. Greenberg, Jeanne K. Drinko, Maureen Martin, Deborah A. Agler, James D. Thomas

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Abstract

OBJECTIVES: The aim of this study was to use real-time three-dimensional echocardiography (3DE) to investigate the quantitative relation between minimal left ventricular (LV) outflow tract area (ALVOT) and maximal LV outflow tract (LVOT) velocity in patients with hypertrophic obstructive cardiomyopathy (HCM). BACKGROUND: In patients with HCM, LVOT velocity should change inversely with minimal ALVOT unless LVOT obstruction reduces the pumping capacity of the ventricle. METHODS: A total of 25 patients with HCM with systolic anterior motion (SAM) of the mitral valve leaflets underwent real-time 3DE. The smallest ALVOT during systole was measured using anatomically oriented two-dimensional "C-planes" within the pyramidal 3DE volume. Maximal velocity across LVOT was evaluated by two-dimensional Doppler echocardiography (2DE). For comparison with 3DE ALVOT, the SAM-septal distance was determined by 2DE. RESULTS: Real-time 3DE provided unique information about the dynamic SAM-septal relation during systole, with ALVOT ranging from 0.6 to 5.2 cm2 (mean: 2.2 ± 1.4 cm2). Maximal velocity (v) correlated inversely with ALVOT (v = 496 ALVOT-0.80, r = -0.95, p < 0.001), but the exponent (-0.80) was significantly different from -1.0 (95% confidence interval: -0.67 to -0.92), indicating a significant impact of small ALVOT on the peak LVOT flow rate. By comparison, the best correlation between velocity and 2DE SAM-septal distance was significantly (p < 0.01) poorer at -0.83, indicating the superiority of 3DE for assessing ALVOT. CONCLUSIONS: Three-dimensional echocardiography-measured ALVOT provides an assessment of HCM geometry that is superior to 2DE methods. These data indicate that the peak LVOT flow rate appears to be significantly decreased by reduced ALVOT. Real-time 3DE is a potentially valuable clinical tool for assessing patients with HCM.

Original languageEnglish
Pages (from-to)308-314
Number of pages7
JournalJournal of the American College of Cardiology
Volume39
Issue number2
DOIs
StatePublished - 16 Jan 2002

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Hypertrophic Cardiomyopathy
Three-Dimensional Echocardiography
Systole
Doppler Echocardiography
Mitral Valve
Confidence Intervals

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Qin, Jian Xin ; Shiota, Takahiro ; Lever, Harry M. ; Rubin, David N. ; Bauer, Fabrice ; Kim, Yong-Jin ; Sitges, Marta ; Greenberg, Neil L. ; Drinko, Jeanne K. ; Martin, Maureen ; Agler, Deborah A. ; Thomas, James D. / Impact of left ventricular outflow tract area on systolic outflow velocity in hypertrophic cardiomyopathy : A real-time three-dimensional echocardiographic study. In: Journal of the American College of Cardiology. 2002 ; Vol. 39, No. 2. pp. 308-314.
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abstract = "OBJECTIVES: The aim of this study was to use real-time three-dimensional echocardiography (3DE) to investigate the quantitative relation between minimal left ventricular (LV) outflow tract area (ALVOT) and maximal LV outflow tract (LVOT) velocity in patients with hypertrophic obstructive cardiomyopathy (HCM). BACKGROUND: In patients with HCM, LVOT velocity should change inversely with minimal ALVOT unless LVOT obstruction reduces the pumping capacity of the ventricle. METHODS: A total of 25 patients with HCM with systolic anterior motion (SAM) of the mitral valve leaflets underwent real-time 3DE. The smallest ALVOT during systole was measured using anatomically oriented two-dimensional {"}C-planes{"} within the pyramidal 3DE volume. Maximal velocity across LVOT was evaluated by two-dimensional Doppler echocardiography (2DE). For comparison with 3DE ALVOT, the SAM-septal distance was determined by 2DE. RESULTS: Real-time 3DE provided unique information about the dynamic SAM-septal relation during systole, with ALVOT ranging from 0.6 to 5.2 cm2 (mean: 2.2 ± 1.4 cm2). Maximal velocity (v) correlated inversely with ALVOT (v = 496 ALVOT-0.80, r = -0.95, p < 0.001), but the exponent (-0.80) was significantly different from -1.0 (95{\%} confidence interval: -0.67 to -0.92), indicating a significant impact of small ALVOT on the peak LVOT flow rate. By comparison, the best correlation between velocity and 2DE SAM-septal distance was significantly (p < 0.01) poorer at -0.83, indicating the superiority of 3DE for assessing ALVOT. CONCLUSIONS: Three-dimensional echocardiography-measured ALVOT provides an assessment of HCM geometry that is superior to 2DE methods. These data indicate that the peak LVOT flow rate appears to be significantly decreased by reduced ALVOT. Real-time 3DE is a potentially valuable clinical tool for assessing patients with HCM.",
author = "Qin, {Jian Xin} and Takahiro Shiota and Lever, {Harry M.} and Rubin, {David N.} and Fabrice Bauer and Yong-Jin Kim and Marta Sitges and Greenberg, {Neil L.} and Drinko, {Jeanne K.} and Maureen Martin and Agler, {Deborah A.} and Thomas, {James D.}",
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Impact of left ventricular outflow tract area on systolic outflow velocity in hypertrophic cardiomyopathy : A real-time three-dimensional echocardiographic study. / Qin, Jian Xin; Shiota, Takahiro; Lever, Harry M.; Rubin, David N.; Bauer, Fabrice; Kim, Yong-Jin; Sitges, Marta; Greenberg, Neil L.; Drinko, Jeanne K.; Martin, Maureen; Agler, Deborah A.; Thomas, James D.

In: Journal of the American College of Cardiology, Vol. 39, No. 2, 16.01.2002, p. 308-314.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Impact of left ventricular outflow tract area on systolic outflow velocity in hypertrophic cardiomyopathy

T2 - A real-time three-dimensional echocardiographic study

AU - Qin, Jian Xin

AU - Shiota, Takahiro

AU - Lever, Harry M.

AU - Rubin, David N.

AU - Bauer, Fabrice

AU - Kim, Yong-Jin

AU - Sitges, Marta

AU - Greenberg, Neil L.

AU - Drinko, Jeanne K.

AU - Martin, Maureen

AU - Agler, Deborah A.

AU - Thomas, James D.

PY - 2002/1/16

Y1 - 2002/1/16

N2 - OBJECTIVES: The aim of this study was to use real-time three-dimensional echocardiography (3DE) to investigate the quantitative relation between minimal left ventricular (LV) outflow tract area (ALVOT) and maximal LV outflow tract (LVOT) velocity in patients with hypertrophic obstructive cardiomyopathy (HCM). BACKGROUND: In patients with HCM, LVOT velocity should change inversely with minimal ALVOT unless LVOT obstruction reduces the pumping capacity of the ventricle. METHODS: A total of 25 patients with HCM with systolic anterior motion (SAM) of the mitral valve leaflets underwent real-time 3DE. The smallest ALVOT during systole was measured using anatomically oriented two-dimensional "C-planes" within the pyramidal 3DE volume. Maximal velocity across LVOT was evaluated by two-dimensional Doppler echocardiography (2DE). For comparison with 3DE ALVOT, the SAM-septal distance was determined by 2DE. RESULTS: Real-time 3DE provided unique information about the dynamic SAM-septal relation during systole, with ALVOT ranging from 0.6 to 5.2 cm2 (mean: 2.2 ± 1.4 cm2). Maximal velocity (v) correlated inversely with ALVOT (v = 496 ALVOT-0.80, r = -0.95, p < 0.001), but the exponent (-0.80) was significantly different from -1.0 (95% confidence interval: -0.67 to -0.92), indicating a significant impact of small ALVOT on the peak LVOT flow rate. By comparison, the best correlation between velocity and 2DE SAM-septal distance was significantly (p < 0.01) poorer at -0.83, indicating the superiority of 3DE for assessing ALVOT. CONCLUSIONS: Three-dimensional echocardiography-measured ALVOT provides an assessment of HCM geometry that is superior to 2DE methods. These data indicate that the peak LVOT flow rate appears to be significantly decreased by reduced ALVOT. Real-time 3DE is a potentially valuable clinical tool for assessing patients with HCM.

AB - OBJECTIVES: The aim of this study was to use real-time three-dimensional echocardiography (3DE) to investigate the quantitative relation between minimal left ventricular (LV) outflow tract area (ALVOT) and maximal LV outflow tract (LVOT) velocity in patients with hypertrophic obstructive cardiomyopathy (HCM). BACKGROUND: In patients with HCM, LVOT velocity should change inversely with minimal ALVOT unless LVOT obstruction reduces the pumping capacity of the ventricle. METHODS: A total of 25 patients with HCM with systolic anterior motion (SAM) of the mitral valve leaflets underwent real-time 3DE. The smallest ALVOT during systole was measured using anatomically oriented two-dimensional "C-planes" within the pyramidal 3DE volume. Maximal velocity across LVOT was evaluated by two-dimensional Doppler echocardiography (2DE). For comparison with 3DE ALVOT, the SAM-septal distance was determined by 2DE. RESULTS: Real-time 3DE provided unique information about the dynamic SAM-septal relation during systole, with ALVOT ranging from 0.6 to 5.2 cm2 (mean: 2.2 ± 1.4 cm2). Maximal velocity (v) correlated inversely with ALVOT (v = 496 ALVOT-0.80, r = -0.95, p < 0.001), but the exponent (-0.80) was significantly different from -1.0 (95% confidence interval: -0.67 to -0.92), indicating a significant impact of small ALVOT on the peak LVOT flow rate. By comparison, the best correlation between velocity and 2DE SAM-septal distance was significantly (p < 0.01) poorer at -0.83, indicating the superiority of 3DE for assessing ALVOT. CONCLUSIONS: Three-dimensional echocardiography-measured ALVOT provides an assessment of HCM geometry that is superior to 2DE methods. These data indicate that the peak LVOT flow rate appears to be significantly decreased by reduced ALVOT. Real-time 3DE is a potentially valuable clinical tool for assessing patients with HCM.

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U2 - 10.1016/S0735-1097(01)01722-3

DO - 10.1016/S0735-1097(01)01722-3

M3 - Article

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AN - SCOPUS:0037116567

VL - 39

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EP - 314

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 2

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