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Gårdinger Y, Malmgren A, Hlebowicz J, Dencker M. Effect of food intake on echocardiographic measurements in healthy elderly. Echocardiography 2022; 39:811-818. [PMID: 35606943 DOI: 10.1111/echo.15368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/04/2022] [Accepted: 05/10/2022] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE This study evaluates whether food intake affects systolic and diastolic echocardiographic measurements in healthy seniors. METHODS Thirty healthy subjects 65-70 years of age were investigated with echocardiography, at fasting and then 30, 90, and 180 min after a meal. RESULTS After 30 min the biggest changes were seen in left ventricular wall stress and myocardial performance index with a decrease of 45% and 33%, respectively, compared to fasting values. Significant (p < .05) increases also were seen in left ventricular stroke volume, left ventricular cardiac output, left ventricular cardiac index, left ventricular outflow velocity-time integral, peak of early diastolic (E) and late diastolic (A) mitral flow velocities, the E/A ratio, pulsed tissue Doppler peak systolic (s') and early (e') and late (a') diastolic velocities, pulmonary vein peak velocities in systole (S) and diastole (D), mitral annular plane systolic excursion (MAPSE), tricuspid annular plane systolic excursion (TAPSE), and global longitudinal strain (GLS) (increases ranging 6%-19%). After 90 min there remained a decrease in wall stress and myocardial performance index of 31% and 17%, respectively, and smaller, but still significant, changes could be seen in left ventricular stroke volume, left ventricular outflow velocity-time integral, MAPSE (lateral), TAPSE, GLS, and a few pulsed tissue Doppler peak systolic velocities and late diastolic velocities. An increase also could be seen in deceleration time of E-wave (DT). After 180 min, all variables except DT were back at baseline or below. No significant changes were seen in S/D ratio, lateral early diastolic velocity (e' lateral) and E/e'ratio. CONCLUSIONS This study shows that food intake affects commonly used echocardiographic parameters, both systolic and diastolic, in healthy seniors. With a few exceptions, the changes seen in the older population were less pronounced than previous studies in younger subjects.
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Affiliation(s)
- Ylva Gårdinger
- Department of Translational Medicine, Unit of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund University, Malmö, Sweden.,Department of Translational Medicine, Unit of Radiology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Andreas Malmgren
- Department of Translational Medicine, Unit of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Joanna Hlebowicz
- Department of Clinical Sciences, Division of Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - Magnus Dencker
- Department of Translational Medicine, Unit of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
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Bayonas-Ruiz A, Muñoz-Franco FM, Ferrer V, Pérez-Caballero C, Sabater-Molina M, Tomé-Esteban MT, Bonacasa B. Cardiopulmonary Exercise Test in Patients with Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10112312. [PMID: 34070695 PMCID: PMC8198116 DOI: 10.3390/jcm10112312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 05/16/2021] [Accepted: 05/23/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patients with chronic diseases frequently adapt their lifestyles to their functional limitations. Functional capacity in Hypertrophic Cardiomyopathy (HCM) can be assessed by stress testing. We aim to review and analyze the available data from the literature on the value of Cardiopulmonary Exercise Test (CPET) in HCM. Objective measurements from CPET are used for evaluation of patient response to traditional and new developing therapeutic measurements. METHODS A systematic review of the literature was conducted in PubMed, Web of Science and Cochrane in Mar-20. The original search yielded 2628 results. One hundred and two full texts were read after the first screening, of which, 69 were included for qualitative synthesis. Relevant variables to be included in the review were set and 17 were selected, including comorbidities, body mass index (BMI), cardiac-related symptoms, echocardiographic variables, medications and outcomes. RESULTS Study sample consisted of 69 research articles, including 11,672 patients (48 ± 14 years old, 65.9%/34.1% men/women). Treadmill was the most common instrument employed (n = 37 studies), followed by upright cycle-ergometer (n = 16 studies). Mean maximal oxygen consumption (VO2max) was 22.3 ± 3.8 mL·kg-1·min-1. The highest average values were observed in supine and upright cycle-ergometer (25.3 ± 6.5 and 24.8 ± 9.1 mL·kg-1·min-1; respectively). Oxygen consumption in the anaerobic threshold (ATVO2) was reported in 18 publications. Left ventricular outflow tract gradient (LVOT) > 30 mmHg was present at baseline in 31.4% of cases. It increased to 49% during exercise. Proportion of abnormal blood pressure response (ABPRE) was higher in severe (>20 mm) vs. mild hypertrophy groups (17.9% vs. 13.6%, p < 0.001). Mean VO2max was not significantly different between severe vs. milder hypertrophy, or for obstructive vs. non-obstructive groups. Occurrence of arrhythmias during functional assessment was higher among younger adults (5.42% vs. 1.69% in older adults, p < 0.001). Twenty-three publications (9145 patients) evaluated the prognostic value of exercise capacity. There were 8.5% total deaths, 6.7% cardiovascular deaths, 3.0% sudden cardiac deaths (SCD), 1.2% heart failure death, 0.6% resuscitated cardiac arrests, 1.1% transplants, 2.6% implantable cardioverter defibrillator (ICD) therapies and 1.2 strokes (mean follow-up: 3.81 ± 2.77 years). VO2max, ATVO2, METs, % of age-gender predicted VO2max, % of age-gender predicted METs, ABPRE and ventricular arrhythmias were significantly associated with major outcomes individually. Mean VO2max was reduced in patients who reached the combined cardiovascular death outcome compared to those who survived (-6.20 mL·kg-1·min-1; CI 95%: -7.95, -4.46; p < 0.01). CONCLUSIONS CPET is a valuable tool and can safely perform for assessment of physical functional capacity in patients with HCM. VO2max is the most common performance measurement evaluated in functional studies, showing higher values in those based on cycle-ergometer compared to treadmill. Subgroup analysis shows that exercise intolerance seems to be more related to age, medication and comorbidities than HCM phenotype itself. Lower VO2max is consistently seen in HCM patients at major cardiovascular risk.
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Affiliation(s)
- Adrián Bayonas-Ruiz
- Human Physiology Area, Faculty of Sport Sciences, University of Murcia, Santiago de la Ribera-San Javier, 30720 Murcia, Spain
| | | | - Vicente Ferrer
- Physiotherapy Department, Faculty of Medicine, Campus of Espinardo, University of Murcia, 30100 Murcia, Spain
| | - Carlos Pérez-Caballero
- Sports Activities Service, Campus of Espinardo, University of Murcia, 30100 Murcia, Spain
| | - María Sabater-Molina
- Inherited Cardiopathies Unit, Virgen de la Arrixaca University Hospital, El Palmar, 30120 Murcia, Spain
| | - María Teresa Tomé-Esteban
- Cardiovascular Clinical Academic Group, Inherited Cardiovascular Disease Unit, St George's Hospital NHS Foundation Trust, St George's University of London, London SW17 0QT, UK
| | - Bárbara Bonacasa
- Human Physiology Area, Faculty of Sport Sciences, University of Murcia, Santiago de la Ribera-San Javier, 30720 Murcia, Spain
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Gnanenthiran SR, Naoum C, Hanzek D, Pogrebizhsky Z, Martin D, Kritharides L, Yiannikas J. Feeding Induces Left Atrial Compression and Impedes Cardiac Filling in Patients With Large Hiatal Hernia. J Am Soc Echocardiogr 2018; 32:375-384. [PMID: 30473406 DOI: 10.1016/j.echo.2018.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Patients with large hiatal hernias (HH) frequently experience postprandial dyspnea. The aim of this study was to evaluate whether feeding induced cardiac compression in these patients using echocardiography. METHODS Transthoracic echocardiography was performed during fasting and 30 min after feeding (300 g rice pudding) in patients with HHs (n = 32; mean age, 72 ± 9 years). A subset of patients (n = 15; mean age, 76 ± 6 years) were evaluated postoperatively. RESULTS Preoperatively, feeding decreased left atrial (LA) volumes (maximal 27.4 ± 11.3 vs 19.2 ± 9.7 mL/m2, P < .001; minimal 13.1 ± 7.0 vs 6.9 ± 5.1 mL/m2, P < .001), and increased LA inflow velocities (systolic wave 0.62 ± 0.14 vs 0.77 ± 0.17 m/sec, P < .01; diastolic wave 0.46 ± 0.13 vs 0.59 ± 0.13 m/sec, P < .01), mitral inflow velocities (E wave 0.79 ± 0.17 vs 0.94 ± 0.19 m/sec, P < .01; A wave 0.93 ± 0.20 vs 1.05 ± 0.22 m/sec, P < .01), and E/E' ratio (12.1 ± 2.7 vs 13.7 ± 3.9, P < .01). Cardiac output (6.3 ± 1.6 vs 7.24 ± 2.0 L, P < .01) increased postprandially by marked heart rate augmentation (68.8 ± 7.0 vs 84.2 ± 8.4 beats/min, P < .01), with modest stroke volume increase (88.5 ± 16.7 vs 94.3 ± 19.5 mL, P = .03). After HH surgery, feeding did not change LA volumes (maximal 52.9 ± 13.6 vs 53.4 ± 12.5 mL, P = .89; minimal 28.6 ± 12.2 vs 27.4 ± 8.7 mL, P = .59) or E/E' ratio (10.9 ± 2.1 vs 11.3 ± 2.3) and induced more modest alterations in LA inflow (systolic wave 0.58 ± 0.17 vs 0.68 ± 0.16 m/sec, P = .01; diastolic wave 0.41 ± 0.12 vs 0.47 ± 0.13 m/sec, P = .01) and mitral inflow (E wave 0.69 ± 0.15 vs 0.80 ± 0.13 m/sec, P < .01; A wave 0.92 ± 0.13 vs 1.01 ± 0.18 m/sec, P = .02). Postoperatively, feeding increased cardiac output by substantial stroke volume augmentation (81.9 ± 16.5 vs 90.8 ± 16.0 mL, P = .01), with only modest increase in heart rate (69.8 ± 9.1 vs 75.9 ± 10.5 beats/min, P < .01). CONCLUSIONS Feeding produces marked LA compression in patients with HHs, inducing compensatory exaggerated responses in cardiac inflow and hemodynamic status. These compensatory mechanisms improve postoperatively following resolution of LA compression, likely explaining the debility noted preoperatively.
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Affiliation(s)
| | - Christopher Naoum
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia
| | - Dianna Hanzek
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia
| | - Zoya Pogrebizhsky
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia
| | - David Martin
- Department of Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Sydney, Australia
| | - Leonard Kritharides
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia
| | - John Yiannikas
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia.
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Finocchiaro G, Magavern E, Sinagra G, Ashley E, Papadakis M, Tome-Esteban M, Sharma S, Olivotto I. Impact of Demographic Features, Lifestyle, and Comorbidities on the Clinical Expression of Hypertrophic Cardiomyopathy. J Am Heart Assoc 2017; 6:JAHA.117.007161. [PMID: 29237589 PMCID: PMC5779031 DOI: 10.1161/jaha.117.007161] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Gherardo Finocchiaro
- Molecular and Clinical Sciences Research Institute Cardiology Clinical Academic Group, St George's, University of London, London, United Kingdom
| | - Emma Magavern
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | | | | | - Michael Papadakis
- Molecular and Clinical Sciences Research Institute Cardiology Clinical Academic Group, St George's, University of London, London, United Kingdom
| | - Maite Tome-Esteban
- Molecular and Clinical Sciences Research Institute Cardiology Clinical Academic Group, St George's, University of London, London, United Kingdom
| | - Sanjay Sharma
- Molecular and Clinical Sciences Research Institute Cardiology Clinical Academic Group, St George's, University of London, London, United Kingdom
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
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Adams JC, Bois JP, Masaki M, Yuasa T, Oh JK, Ommen SR, Nishimura RA, Klarich KW. Postprandial Hemodynamics in Hypertrophic Cardiomyopathy. Echocardiography 2015; 32:1614-20. [DOI: 10.1111/echo.12951] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jonathon C. Adams
- Division of Cardiovascular Diseases; Mayo Clinic; Scottsdale Arizona
| | - John P. Bois
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - Mitsuru Masaki
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - Toshinori Yuasa
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - Jae K. Oh
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - Steve R. Ommen
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - Rick A. Nishimura
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
| | - Kyle W. Klarich
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester Minnesota
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Dieden A, Gårdinger Y, Hlebowicz J, Björgell O, Dencker M. Effect of food intake on left and right ventricular systolic tissue Doppler measurements. Clin Physiol Funct Imaging 2015; 36:396-400. [PMID: 25976703 DOI: 10.1111/cpf.12242] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 01/27/2015] [Indexed: 11/27/2022]
Abstract
Systolic tissue Doppler measurements (s') have been used to measure the velocity in myocardial motion and are a valuable tool for evaluating the systolic function of the left and right ventricles. Digestion of food is known to significantly alter hemodynamics and may therefore affect s'. The effect of food intake on s' parameters has not yet been studied. We assessed whether s' is affected by food intake. Nineteen healthy subjects aged 26·2 ± 4·2 years were investigated. s' was measured with pulsed tissue Doppler imaging in the right and left ventricles before the subjects ate a standardized meal and also 30 and 110 min after the meal. Three measurements were taken in each projection, and a mean value was calculated for each. s' increased significantly (P<0·05) from fasting to 30 min after food intake in every measured site except in the left inferolateral wall (P = 0·15, NS). Several, but not all, variables returned to base value 110 min after food intake. This study shows that food intake affects the tissue Doppler variables used to evaluate systolic heart function. Further studies are needed in older healthy subjects and older subjects with various cardiovascular diseases.
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Affiliation(s)
- Anna Dieden
- Department of Clinical Sciences, Department of Medical Imaging and Physiology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Ylva Gårdinger
- Department of Clinical Sciences, Department of Medical Imaging and Physiology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Joanna Hlebowicz
- Division of Medicine, Department of Clinical Sciences, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Ola Björgell
- Department of Clinical Sciences, Department of Medical Imaging and Physiology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Magnus Dencker
- Department of Clinical Sciences, Department of Medical Imaging and Physiology, Skåne University Hospital, Lund University, Malmö, Sweden
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Naoum C, Puranik R, Falk GL, Yiannikas J, Kritharides L. Postprandial left atrial filling is impaired in patients with large hiatal hernia and improves following surgical repair. Int J Cardiol 2014; 182:291-3. [PMID: 25585365 DOI: 10.1016/j.ijcard.2014.12.133] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 12/29/2014] [Indexed: 02/08/2023]
Affiliation(s)
- Christopher Naoum
- Department of Cardiology, Concord Hospital, Sydney Medical School, The University of Sydney, Sydney, Hospital Road, Concord, NSW 2139, Australia
| | - Rajesh Puranik
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney Medical School, The University of Sydney, Sydney, Missenden Road, Camperdown, NSW 2050, Australia
| | - Gregory L Falk
- Department of Upper Gastrointestinal Surgery, Concord Hospital, Sydney Medical School, The University of Sydney, Sydney, Hospital Road, Concord, NSW 2139, Australia
| | - John Yiannikas
- Department of Cardiology, Concord Hospital, Sydney Medical School, The University of Sydney, Sydney, Hospital Road, Concord, NSW 2139, Australia
| | - Leonard Kritharides
- Department of Cardiology, Concord Hospital, Sydney Medical School, The University of Sydney, Sydney, Hospital Road, Concord, NSW 2139, Australia.
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Feiner E, Arabadjian M, Winson G, Kim B, Chaudhry F, Sherrid MV. Post-Prandial Upright Exercise Echocardiography in Hypertrophic Cardiomyopathy. J Am Coll Cardiol 2013; 61:2487-2488. [DOI: 10.1016/j.jacc.2013.02.079] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Revised: 02/08/2013] [Accepted: 02/12/2013] [Indexed: 11/29/2022]
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Dencker M, Björgell O, Hlebowicz J. Effect of food intake on commonly used pulsed Doppler and tissue Doppler measurements. Echocardiography 2011; 28:843-7. [PMID: 21827540 DOI: 10.1111/j.1540-8175.2011.01451.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This study evaluates the effect of food intake on commonly used pulsed Doppler and tissue Doppler measurements. METHODS Twenty-three healthy subjects aged 25.6 ± 4.5 years were investigated. A wide selection of pulsed Doppler and tissue Doppler variables were measured before a standardized meal as well as and 30 and 110 minutes afterwards. RESULTS The following variables increased significantly (P < 0.05) 30 minutes after food intake: left ventricular stroke volume, left ventricular cardiac output, left ventricular outflow velocity-time integral, peak of early diastolic (E) and late diastolic (A) mitral flow velocities, pulmonary vein peak velocities in systole (S) and in diastole (D), S/D, pulsed tissue Doppler peak systolic velocities, and late diastolic velocities. Deceleration time of E-wave decreased significantly (P < 0.05). The change in measured variables between fasting and 30 minutes after the food intake ranged from 7% to 28%. There were no significant (P > 0.05) changes in E/A, early diastolic tissue Doppler velocities (e'), and E/e'. Most, but not all variables returned to baseline values 110 minutes after food intake. CONCLUSIONS This study shows that food intake affects several echocardiographic variables used to routinely assess diastolic function and hemodynamics. Further studies are warranted in older healthy subjects and in patients with various cardiac diseases to determine whether the findings are reproducible in such populations.
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Affiliation(s)
- Magnus Dencker
- Department of Clinical Physiology and Nuclear Medicine, Lund University, Skåne University Hospital, Malmö, Sweden.
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Kansal MM, Mookadam F, Tajik AJ. Drink more, and eat less: advice in obstructive hypertrophic cardiomyopathy. Am J Cardiol 2010; 106:1313-6. [PMID: 21029830 DOI: 10.1016/j.amjcard.2010.06.061] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 06/28/2010] [Accepted: 06/28/2010] [Indexed: 10/19/2022]
Abstract
This report describes a series of symptomatic patients with obstructive hypertrophic cardiomyopathy with significant postprandial hemodynamic changes. This finding was identified by history, clinical examination, and echocardiography in 6 consecutive symptomatic patients referred for the evaluation of ventricular septal reduction therapy. Counseling these patients with dietary changes to include small frequent meals and to increase noncaffeinated fluid intake resulted in reductions in symptoms. In conclusion, severe symptoms in obstructive hypertrophic cardiomyopathy unresponsive to pharmacologic treatment frequently result in referral for definitive septal reduction therapy through surgery or, less frequently, alcohol septal ablation therapy. However, recognition of postprandial exacerbation in symptomatic patients may allow for nonpharmacologic dietary interventions that may obviate the need for more invasive therapies and their associated complications.
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Adams JC, Ommen SR, Klarich KW, Tajik AJ, Nishimura RA. Significance of postprandial symptom exacerbation in hypertrophic cardiomyopathy. Am J Cardiol 2010; 105:990-2. [PMID: 20346318 DOI: 10.1016/j.amjcard.2009.11.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Revised: 11/13/2009] [Accepted: 11/13/2009] [Indexed: 11/26/2022]
Abstract
Patients with hypertrophic cardiomyopathy (HC) can experience exacerbation of exertional symptoms after a meal. The present study was designed to determine the prevalence and clinical correlates of postprandial symptom exacerbation (PPSE) in patients with HC. The records of 558 patients with HC and PPSE data who had undergone echocardiography at our institution from 2002 to 2006 were reviewed. Continuous-wave Doppler velocities were used to determine the left ventricular outflow tract gradient. Left ventricular filling was assessed using transmitral velocity curves. The Minnesota Living With Heart Failure questionnaire was administered to measure symptom limitations. A multivariate regression model was developed to determine the independent correlates with PPSE. Of the 558 patients whose records were reviewed, 189 (33.8%) had PPSE. The patients with PPSE were more likely to experience New York Heart Association class III/IV dyspnea or presyncope. PPSE was associated with greater resting outflow gradients and lower perceived quality of life. In conclusion, patients presenting with severe postprandial symptoms and reduced quality of life should be carefully evaluated for the presence of dynamic left ventricular outflow tract obstruction.
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12
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Anavekar NS, Oh JK. Doppler echocardiography: A contemporary review. J Cardiol 2009; 54:347-58. [DOI: 10.1016/j.jjcc.2009.10.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 09/14/2009] [Accepted: 09/28/2009] [Indexed: 10/20/2022]
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13
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Wesley Reagan B, Helmcke F, Kenneth Kerut E. Commonly Used Respiratory and Pharmacologic Interventions in the Echocardiography Laboratory. Echocardiography 2005; 22:455-60. [PMID: 15901303 DOI: 10.1111/j.1540-8175.2005.40095.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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