Author + information
- Received December 3, 1989
- Revision received August 20, 1991
- Accepted September 4, 1991
- Published online March 1, 1992.
- ↵§Address for reprints: Horst Kuhn, MD, Städtische Kliniken Bielefeld, Department of Internal Medicine II, Teutoburger Strasse 50, D-4800 Bielefeld, Germany.
To define alterations in the magnitude of the left ventricular outflow tract gradient during supine exercise, 10 patients with hypertrophic obstructive cardiomyopathy were studied under basal conditions and during exercise and recovery with simultaneous invasive hemodynamic measurements, particularly of the peak to peak systolic pressure gradient across the left ventricular outflow tract.
Basal outflow pressure gradient ranged from 0 to 89 mm Hg (average 37.4 ± 9.6). No increase was observed during 5 min of exercise (average 29.6 ± 10 mm Hg, range 0 to 91; p = NS), even though arterial blood pressure, heart rate and cardiac index increased significantly in association with a decrease in peripheral vascular resistance. However, a rapid and highly significant increase in left ventricular outflow gradient occurred after exereise was completed (average 83.5 ±11.4 mm Hg, range 10 to 130; p < 0.001), while arterial blood pressure, heart rate and cardiac index closely approached basal levels and total peripheral vascular resistance increased.
In contrast to previous assumptions regarding the behavior of the outflow gradient in hypertrophic cardiomyopathy, obstruction to left ventricular outflow increases afterrather than during supine exercise. Rapid changes in preload during recovery represent the most likely explanation for the postexercise development of outflow obstruction. New considerations regarding the mechanisms of sudden cardiac death and the therapeutic approach in patients with hypertrophic cardiomyopathy may result from this pathophysiologic observation.
- Received December 3, 1989.
- Revision received August 20, 1991.
- Accepted September 4, 1991.
- American College of Cardiology Foundation