Unmasking Obstruction in Hypertrophic Cardiomyopathy With Postprandial Resting and Treadmill Stress Echocardiography

Unmasking Obstruction in Hypertrophic Cardiomyopathy With Postprandial Resting and Treadmill Stress Echocardiography is organized by American Society of Echocardiography (ASE).

Release Date: October 1, 2024
Expiration Date: October 1, 2025

Description:
Hypertrophic cardiomyopathy (HCM) is the most common inherited heart muscle disease, with a prevalence of 1:500 people, and is characterized by unexplained left ventricular hypertrophy and left ventricular outflow tract obstruction (LVOTO) from systolic anterior motion (SAM) of the mitral valve in approximately 70% of patients.1,2 However, only half of those with LVOTO are identified during echo-cardiography (echo) at rest, despite substantial quality-of-life-limiting symptoms such as exercise intolerance, breathlessness, lightheaded-ness, and angina. Latent LVOTO can be elicited by provocative ma-neuvers that alter preload, afterload, and contractility, such as the Valsalva maneuver, standing, administration of vasoactive drugs, and exercise.3 Prompted by the observation that approximately one-third of patients with obstructive HCM experience worse exer-tional symptoms after eating,4 postprandial echocardiography was found to be useful at provoking LVOTO in prior studies.

Learning Objectives:

• Quantify the effect of eating on LVOTO
• Appreciate the mechanism of increased LVOTO following eating
• Recognize those patients who will be eligible for invasive or drug therapies following post-prandial echocardiography
• Apply standardized echocardiographic methods to assessing these patients
• Consider the true strength of postprandial echo/stress echo in physiologic gradient provocation.