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ȣ - 550182 177 |
| Dynamic Intraventricular Obstruction Associated With Left Ventricular Concentric Geometry in Patients With Hypertension: Dobutamine Stress Echocardiography Study |
| 강동경희대학교병원 심장혈관내과 |
| 손일석, 배동옥, 조병현, 황희정, 박창범, 진은선, 조진만, 김종진, 배종화 |
Background: We were to evaluate the relation of left ventricular (LV) geometry and dynamic intraventricular obstruction (IVO).
Methods: Prospectively enrolled 38 hypertensive patients (mean age 66.0±9.9 years; 32% male) underwent during dobutamine stress echocardiography (DSE). Concentric geometry was defined by relative wall thickness (RWT, 2x posterior wall thickness at end diastole/LV end-diastolic dimension) over 0.42. The patients with positive exercise electrocardiography, transmural infarction, significant valvular heart disease, atrial fibrillation, beta-blocker therapy, and induced ischemia during DSE were excluded. IVO during DSE was defined as a late-peaking intraventricular pressure gradient (IVPG) >30mmHg.
Results: The patients with RWT >0.42 (n=15, concentric group) and with RWT ≤0.42 (n=23, non-concentric group) were not different in terms of age, gender, smoking status, diabetes and used anti-hypertensive drugs. Concentric group had smaller LV cavity and volume, and more increased interventricular septum and basal septal thickness than non-concentric group. At rest, during peak dose of dobutamine, and after nitroglycerin, IVPG was higher in concentric group. The development of an IVO during DSE was higher in concentric group.
Conclusions: LV concentric geometry was associated with the development of an IVO during DSE in patients with hypertension who might be good candidate for beta-blocker therapy.
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Non-concentric (n=23) |
Concentric (n=15) |
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Basal septal thickness, mm |
12.2±1.7 |
13.6±1.5* |
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IVSd, mm |
9.3±1.3 |
10.5±1.2* |
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LV mass index, g/m2 |
86.4±15.5 |
85.7±20.8 |
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End-diastolic volume/BSA, mL/m2 |
63.7±14.7 |
46.1±11.6* |
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End-systolic volume/BSA, mL/m2 |
19.9±5.1 |
14.6±5.3* |
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IVPG, base, mmHg |
2.4±2.0 |
6.8±6.9† |
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IVPG, after nitroglycerin, mmHg |
3.2±1.9 |
9.4±10.0† |
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IVPG, after peak dose of dobutamine, mmHg |
49.5±33.9 |
86.9±42.1* |
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IVO, n(%) |
14(61%) |
13(87%)† |
Data are expressed as mean±SD. IVSd, end-diastolic interventricular septal thickness ; LV, left ventricular; BSA, body surface area; IVPG, intraventricular pressure gradient ; IVO, intraventricular obstruction(pressure gradient >30mmHg after dobutamine infusion) * P< 0.01, †P<0.05 vs Non-concentric.
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