Key result
Abnormal venous residual volume fraction occurs in ~30% of symptomatic obstructive HCM patients versus controls.
Why the study?
Left ventricular outflow-tract obstruction in hypertrophic cardiomyopathy causes disabling exercise symptoms and is influenced by venous return, but venous dysfunction in these patients was not well evaluated.
Is venous dysfunction more prevalent in symptomatic obstructive HCM patients compared to healthy controls, and how does it relate to left ventricular outflow-tract obstruction?
Cross-Sectional (n=40)
Single-blind
No
Is venous dysfunction more prevalent in symptomatic obstructive HCM patients compared to healthy controls, and how does it relate to left ventricular outflow-tract obstruction?
Venous insufficiency is present in nearly a third of symptomatic obstructive HCM patients and is associated with smaller left ventricular cavity volumes, suggesting a potential role in the pathophysiology of exercise symptoms.
Answers are grounded in this paper and cite their sources.
Venous dysfunction may occur in symptomatic obstructive HCM; leaves open its mechanistic role and need for prospective validation.
Hypertrophic cardiomyopathies (HCM) can be complicated by left ventricular outflow-tract obstruction (LVOTO) responsible for disabling exercise symptoms, a phenomenon influenced by hemodynamic factors including venous return. We aimed to evaluate venous dysfunction in obstructive HCM patients compared to healthy controls, and to investigate the relationship between venous dysfunction parameters and LVOTO in HCM. This is a clinical, monocentric, prospective, pilot study, in a tertiary care center. We investigated venous function using venous air plethysmography, and endothelial function. Among the 30 symptomatic obstructive HCM patients, 30% (n = 9) presented abnormal venous residual volume fraction (RVFv) which translates in elevated ambulatory venous pressure vs. 0% in the 10 healthy controls (p < 0.05). Comparing obstructive HCM patients with abnormal RVFv (n = 9) to other obstructive HCM patients with normal RVFv (n = 21), there were no significant differences in terms of age, sex (67% male), and classical echocardiographic parameters both at rest and during exercise, except for left ventricular end-diastolic volume index which was significantly lower in the group with abnormal RVFv compared to the other HCM patients (40.1 ± 9.0 ml/m2 vs. 50.2 ± 10.6 ml/m2, p = 0.01). Fifty six percent of obstructive HCM patients with abnormal RVFv had an absolute increase in Willebrand factor (vs. 26% of other obstructive HCM patients, p < 0.05). In this pilot monocentric study, venous insufficiency was observed in about 30% of symptomatic obstructive HCM patients. Patients with venous insufficiency had more frequently a smaller LV cavity volume. Due to the small sample size, this study is only hypothesis-generating, and further investigations are needed.
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Réant et al. (2023) conducted a cross-sectional in Symptomatic obstructive hypertrophic cardiomyopathy (n=40). Symptomatic obstructive hypertrophic cardiomyopathy vs. Healthy controls was evaluated on Abnormal venous residual volume fraction (value > 35%) (p=0.049). Abnormal venous residual volume fraction was present in 30% of symptomatic obstructive hypertrophic cardiomyopathy patients compared to 0% of healthy controls.
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