Use of Doppler echocardiography and amyl nitrite inhalation to characterize left ventricular outflow obstruction in hypertrophic cardiomyopathy.

Journal Article (Journal Article)

The presence of left ventricular outflow tract obstruction (LVOTO) of either a resting or dynamic nature may have important therapeutic and prognostic implications in patients with hypertrophic cardiomyopathy (HCM). Doppler echocardiograms combined with amyl nitrite (Amyl) inhalation were performed in 333 consecutive patients referred for suspected HCM to diagnose and categorize the nature and severity of LVOTO. Hypertrophic cardiomyopathy was present by 2-D and M-mode criteria in 145/333 (44 percent) patients. Normal limits of resting and post-Amyl continuous wave Doppler peak left ventricular outflow tract velocities were established in 15 subjects with completely normal 2-D and Doppler echocardiograms. Based on these criteria, of the 145 patients with HCM, 63 (43 percent) were classified as having resting LVOTO, peak velocity 4.2 +/- 1.3 m/s. Among 82 patients with HCM without resting LVOTO, 47 (57 percent) received Amyl. Latent LVOTO was provoked in 25/47 (53 percent), peak post-Amyl velocity 4.5 +/- 1.2 m/s. The remaining 22 (47 percent) had nonobstructive HCM, as indicated by no significant increase in post-Amyl velocity. Among a total 62 subjects receiving Amyl, none experienced serious morbidity or mortality. Doppler echocardiography, in conjunction with Amyl inhalation in selected patients, is a useful noninvasive method to diagnose and categorize patients with HCM according to the nature and severity of LVOTO.

Full Text

Duke Authors

Cited Authors

  • Sheikh, KH; Pearce, FB; Kisslo, J

Published Date

  • February 1990

Published In

Volume / Issue

  • 97 / 2

Start / End Page

  • 389 - 395

PubMed ID

  • 1967573

International Standard Serial Number (ISSN)

  • 0012-3692

Digital Object Identifier (DOI)

  • 10.1378/chest.97.2.389


  • eng

Conference Location

  • United States