Diagnostic Value of Left Ventricular Outflow Area in Patients with Hypertrophic Cardiomyopathy: A Real-Time Three-Dimensional Echocardiographic Study

Shota Fukuda, Harry M. Lever, William J. Stewart, Hung Tran, Jong Min Song, Mi Seong Shin, Neil L. Greenberg, Nozomi Wada, Yoshiki Matsumura, Manatomo Toyono, Nicholas G. Smedira, James D. Thomas, Takahiro Shiota*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

21 Scopus citations

Abstract

Background: Earlier studies demonstrated the ability of real-time 3-dimensional (3D) echocardiography (3DE) to measure left ventricular outflow tract (LVOT) area (ALVOT) in patients with hypertrophic cardiomyopathy (HCM). However, its clinical value is unknown. Objective: We sought to investigate the feasibility and accuracy of real-time 3DE-derived ALVOT to diagnose significant LVOT obstruction in a large number of patients with HCM. Methods: A total of 162 patients with HCM had 3DE by using a volumetric system. The smallest ALVOT during systole was determined by moving a 2-dimensional plane in 3D space. The pressure gradient across LVOT was assessed by continuous wave Doppler method. Provocation was performed in patients without significant LVOT obstruction (pressure gradient across LVOT < 50 mm Hg) at rest. Results: Twenty (12%) patients with poor image quality of 3DE were excluded; 16 (28%) patients with a volumetric system, but only 4 (4%) patients with commercial equipment (P < .001). In the remaining 142 patients, ALVOT inversely correlated with pressure gradient across LVOT both at rest (r = 0.82, P < .001) and after provocation (r = 0.60, P < .001). The value of ALVOT less than 0.85 cm2 and less than 2.0 cm2 predicted resting and provokable LVOT obstruction with sensitivity of 87% and 81%, and specificity of 77% and 90%, respectively. Conclusions: Real-time 3DE measurement of ALVOT was successful in diagnosing and quantifying LVOT obstruction at rest and after provocation in a large number of patients with HCM.

Original languageEnglish (US)
Pages (from-to)789-795
Number of pages7
JournalJournal of the American Society of Echocardiography
Volume21
Issue number7
DOIs
StatePublished - Jul 2008

Keywords

  • Cardiomyopathy
  • Echocardiography
  • Hypertrophy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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