Key result
A baseline left ventricular outflow tract (LVOT) ratio ≤ 0.83 strongly predicted the presence of latent LVOTO during dobutamine stress echocardiography with a sensitivity of 81.1% and specificity of 80.6% in patients without left ventricular hypertrophy.
Why the study?
Does the baseline LVOT ratio predict the development of latent left ventricular outflow tract obstruction during dobutamine stress echocardiography in patients without left ventricular hypertrophy?
Observational (n=199)
Does the baseline LVOT ratio predict the development of latent left ventricular outflow tract obstruction during dobutamine stress echocardiography in patients without left ventricular hypertrophy?
Absolute Event Rate: 0.78% vs 0.89%
p-value: p=<0.001
A baseline LVOT ratio ≤ 0.83 is a strong echocardiographic predictor of latent LVOTO during dobutamine stress in patients without left ventricular hypertrophy.
May aid risk stratification for latent LVOTO in non-LVH patients; hypothesis-generating and requires prospective validation before clinical use.
Left ventricular outflow tract obstruction (LVOTO) is commonly observed in patients with hypertrophic cardiomyopathy (HCM) or left ventricular hypertrophy (LVH). While some patients develop LVOTO at rest, it can also be provoked by physical exertion, and hence termed latent LVOTO (L-LVOTO). Recent reports demonstrated that L-LVOTO develops not only in LVH patients, but also in patients without LVH (non-LVH). However, the prevalence and clinical prognosis of non-LVH patients with L-LVOTO are not yet elucidated. In this study, we retrospectively investigated the echocardiographic features of patients with malignancy who underwent dobutamine stress echocardiography (DSE) to evaluate preoperative cardiac risk. One hundred ninety-nine patients were found not to have LVH or coronary artery disease. Among them, 106 patients exhibited L-LVOTO after DSE. We next compared the baseline echocardiographic features of L-LVOTO (+) patients with those of L-LVOTO (-) patients, and identified the left ventricular outflow tract (LVOT) ratio (systolic LVOT diameter/diastolic LVOT diameter) as a significant predictor of L-LVOTO. An LVOT ratio ≤ 0.83 was the best cutoff value to detect the presence of L-LVOTO, with a sensitivity of 81.1% and specificity of 80.6%. Overall, L-LVOTO was found to develop in almost half of non-LVH patients with malignancy. In addition, the baseline LVOT ratio was strongly related to the presence of L-LVOTO in non-LVH patients. Therefore, patients with dynamic LVOT narrowing may benefit from DSE to detect the presence of L-LVOTO.
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Semba et al. (2012) conducted an observational in Malignancy without left ventricular hypertrophy (n=199). Latent left ventricular outflow tract obstruction (L-LVOTO) vs. No L-LVOTO was evaluated on Baseline LVOT ratio (systolic/diastolic diameter) (p=<0.001). A baseline left ventricular outflow tract (LVOT) ratio ≤ 0.83 strongly predicted the presence of latent LVOTO during dobutamine stress echocardiography with a sensitivity of 81.1% and specificity of 80.6% in patients without left ventricular hypertrophy.
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