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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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Anterior mitral valve leaflet elongation predicts left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy
Session:
Posters 1 - Écran 4 - Doenças do Miocárdio
Speaker:
Sofia Torres
Congress:
CPC 2019
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.1 Myocardial Disease – Pathophysiology and Mechanisms
Session Type:
Posters
FP Number:
---
Authors:
Sofia Torres; Paulo Maia Araújo; Carla De Sousa; CX Resende; Mariana Vasconcelos; Maria Júlia Maciel Barbosa; Filipe Macedo
Abstract
<p><strong>Introduction:</strong> Hypertrophic cardiomyopathy (HCM) is a hereditary cardiac disease with heterogeneous anatomical and clinical phenotypes. Dynamic left ventricular outflow tract obstruction (LVOTO) is frequently present and plays a central role in the development of symptoms in these patients. Structural abnormalities of the mitral valve are common in HCM, but their contributing role in the development of LVOTO has not been completely established.</p> <p><strong>Purpose:</strong> To assess the dimension of mitral valve leaflets in HCM patients and to evaluate its relationship with LVOTO.</p> <p><strong>Methods: </strong>HCM patients and healthy volunteers were studied with a comprehensive echocardiographic examination. Besides regular parameters, septal wall thickness (SWT), anterior and posterior mitral valve leaflet length (AMVLL; PMVLL) were measured using parasternal long axis view. The product of SWT and AMVLL was described as the Septal Anterior Leaflet Product (SALP). Peak LVOT pressure gradient was determined by Doppler evaluation and defined as “obstructive” if it was ≥ 30 mmHg, whether in resting conditions or during a sustained Valsalva maneuver. </p> <p><strong>Results:</strong> A total of 43 patients with HCM (62.8% male, mean age 56 years) and 18 controls (50% male, mean age 41 years) were included in our study. Among HCM patients, 55.8% had the septal asymmetric HCM type. Mean LV mass was 335g and 30% presented LVOTO.</p> <p>Compared with controls, patients with HCM presented increased anterior (31.1+/-4.8mm vs 26.2 +/- 3.7mm, p<0.001) and posterior (21.0+/-4.8 mm vs 17.0 +/- 2.7mm, p<0.001) mitral leaflet lengths.</p> <p>AMVLL and SALP were the only parameters that significantly correlated with LVOT pressure gradient (r= 0.483 and r = 0.608, respectively). This correlation was not found between LVOT gradient and LV mass or SWT (p>0.05). </p> <p>Accordingly, patients with LVOTO presented higher SALP than those without obstruction (621.3 vs 499.4; p=0.043).</p> <p>In fact, AMVLL (p=0.042) and especially SALP (p=0.007) were significant predictors of the maximum LVOT pressure gradient.</p> <p><strong>Conclusion: </strong>In our study, HCM patients presented abnormally long mitral valve leaflets comparing with controls. Anterior mitral valve leaflet length and the combined descriptor SALP were both predictors of the maximum LVOT pressure gradient. Therefore, it may be valuable to report mitral valve leaflets length as well as SALP on routine echocardiographic evaluation of HCM patients.</p>
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