Imaging of left ventricular outflow tract obstruction in hypertrophic cardiomyopathy.

IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Current Opinion in Cardiology Pub Date : 2023-09-01 DOI:10.1097/HCO.0000000000001058
Merrill Stewart, Andrew Elagizi, Yvonne E Gilliland
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Abstract

Purpose of review: The current article reviews obstructive forms of hypertrophic cardiomyopathy and associated morphologic cardiac abnormalities. It focuses on echocardiographic imaging of the left ventricular (LV) outflow tract obstruction, its evaluation, prognostication, and differentiation from other conditions mimicking obstructive hypertrophic cardiomyopathy.

Recent findings: Symptomatic patients with LV outflow tract (LVOT) gradients at least 50 mmHg on maximally tolerated medical therapy are candidates for advanced therapies. Resting echocardiography may only identify 30% of patients with obstructive physiology. Provocative maneuvers are essential for symptomatic patients with hypertrophic cardiomyopathy (HCM). Exercise echocardiography is recommended if they fail to provoke a gradient. Although dynamic LV tract obstruction is seen with obstructive HCM, it is not specific to this condition and exists in other physiologic and pathophysiologic states. Careful clinical evaluation and imaging techniques aid in the differentiation of HCM from these conditions.

Summary: Imaging plays an integral role in the diagnosis, prognosis, and risk stratification of HCM patients. Newer imaging technologies, including 3D transthoracic echocardiography, 3D transesophageal, speckle-derived 2D strain, and cardiac MRI, allow for a better hemodynamic understanding of systolic anterior motion and LV tract obstruction. Evolving techniques, that is, artificial intelligence, will undoubtedly further increase diagnostic capabilities. Newer medical therapies are available with the hope that this will lead to better patient management.

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肥厚性心肌病左室流出道梗阻的影像学表现。
综述目的:本文综述了阻塞性肥厚性心肌病和相关的心脏形态学异常。它侧重于超声心动图成像的左心室(LV)流出道梗阻,其评估,预后,并从其他条件模拟梗阻性肥厚性心肌病的区别。最近的发现:有症状的左室流出道(LVOT)梯度至少50mmhg的患者在最大耐受药物治疗下是高级治疗的候选人。静息超声心动图只能识别30%的患者有阻塞性生理机能。刺激的演习是必要的症状患者肥厚性心肌病(HCM)。如果运动超声心动图不能引起梯度,建议使用。尽管在梗阻性HCM中可以看到动态左室梗阻,但它并不是特定于这种情况,而是存在于其他生理和病理生理状态中。仔细的临床评估和影像学技术有助于HCM与这些疾病的鉴别。摘要:影像在HCM患者的诊断、预后和风险分层中起着不可或缺的作用。较新的成像技术,包括3D经胸超声心动图、3D经食管超声心动图、斑点衍生的2D strain和心脏MRI,可以更好地了解收缩前运动和左室束梗阻的血流动力学。不断发展的技术,即人工智能,无疑将进一步提高诊断能力。新的医学疗法已经出现,希望这将带来更好的病人管理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Current Opinion in Cardiology
Current Opinion in Cardiology 医学-心血管系统
CiteScore
4.20
自引率
4.30%
发文量
78
审稿时长
6-12 weeks
期刊介绍: ​​​​​​Current Opinion in Cardiology is a bimonthly publication offering a unique and wide ranging perspective on the key developments in the field. Each issue features hand-picked review articles from our team of expert editors. With fourteen disciplines published across the year – including arrhythmias, molecular genetics, HDL cholesterol and clinical trials – every issue also contains annotated reference detailing the merits of the most important papers.
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