J Korean Soc Echocardiogr.  1996 Jul;4(1):29-33. 10.4250/jkse.1996.4.1.29.

Diagnosis of Latent Hypertrophic Obstructive Cardiomyopathy with Dobutamine Stress Echocardiography

• Kim KS
• Lee HJ
• Lee MY
• Kang HS
• Cho CW
• Kim MS
• Song JS
• Bae JH

• KMID: 2410403
• DOI: http://doi.org/10.4250/jkse.1996.4.1.29

Abstract

BACKGROUND
In latent type of hypertrophic obstructive cardiomyopathy, there is no pressure gradient at rest in left ventricular outflow tract(LVOT), but it develops with provocation. Dobutamine increase myocardial contractility and may inducce outflow tract obstruction. To evaluate the usefulness of dobutamine induced outflow tract obstruction as a provocation test, nine patients with latent obstructive cardiomyopathy were studied. METHOD: 680 cases of dobutamine stress echocardiography were reviewed. Nine patients developed late peaking outflow velocity pattern in response to dobutamine infusion(inducible group). Ten patients developed early peaking velocity pattern were included as control group. Left ventricular dimension, outflow tract diameter were measured, and pattern of septal hypertrophy was classified. Changes of peak velocity and acceleration time/ejection time ratio (AT/ET) were measured at rest and peak dose dobutamine.
RESULTS
The peak outflow velocity at rest was not different in both groups(1.49±0.45, 1.18±0.11m/sec). Peak velocity and AT/ET ratio were significantly increased in inducible group(4.2±0.9m/sec, 0.66±0.17), but no significant changes were noted in control group. Patients with inducible group had greater septal thickness, smaller outflow tract diameter and greater prevalence of septal bulge morphology.
CONCLUSION
These results suggest that dobutamine stress Doppler echocardiography could be a useful provocation test to diagnosis of latent obstructive cardiogyopathy.

Keyword

Dobutamine stress echocardiography; Latent obstructive cardiomyopathy

MeSH Terms

Acceleration
Cardiomyopathies
Cardiomyopathy, Hypertrophic*
Diagnosis*
Dobutamine*
Echocardiography, Doppler
Echocardiography, Stress*
Humans
Hypertrophy
Methods
Prevalence
Dobutamine

Figure

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  Fig. 1. Continious wave Doppler echocardiographic signals from LVOT at rest(left) and dobutamine infusion(right) in a patient with inducible group. Peak velocity of outflow tract jet increased from 1.3m/sec to 4.5m/sec in response to dobutamine.

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  Fig. 2. Change of velocity and AT/ET ratio of outflow tract ject at rest and dobutamine infusion with continous wave Doppler echocardiography.

Reference

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