Delayed UntwistingThe Mechanistic Link Between Dynamic Obstruction and Exercise Tolerance in Patients With Hypertrophic Obstructive Cardiomyopathy
Jianwen Wang, PhD, MD,
John M. Buergler, MD,
Kumuthavally Veerasamy, RDCS,
Yelena P. Ashton, MBA and
Sherif F. Nagueh, MD*
Methodist DeBakey Heart and Vascular Center, The Methodist Hospital, Houston, Texas
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Figure 1 Examples of Global Deformation and Twist From Control Subjects and HCM Patients With and Without Dynamic Obstruction
(Top) Global longitudinal (A to C), radial (D to F), and circumferential (G to I) strain are shown: a normal control in A, D, and G, hypertrophic obstructive cardiomyopathy (HOCM) in B, E, and H, and hypertrophic cardiomyopathy (HCM) in C, F, and I. Global longitudinal (A vs. B and C) and radial (D vs. E and F) strain were greater in normal control patients compared with those with either obstructive or nonobstructive HCM. There were smaller differences in circumferential strain (G vs. H and I). (Bottom) Twist from the 3 subjects was similar (J vs. K and L).
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Figure 2 Untwisting Delay Versus LVEDP and E/e' Ratio
(A) Regression plot of the correlation between the delay in left ventricular (LV) untwisting (expressed as percent of systolic duration) versus left ventricular end-diastolic pressure (LVEDP) during left heart catheterization in the 25 patients with HOCM. (B) Regression plot of the correlation between the delay in LV untwisting (expressed as percent of systolic duration) versus ratio of mitral peak E velocity to annular early diastolic velocity (E/e') ratio in all HCM patients with and without dynamic obstruction. Abbreviations as in Figure 1.
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Figure 3 Untwisting Delay Versus LVEDV
Regression plot of the correlation between the delay in left ventricular untwisting (expressed as percent of systolic duration) and LVEDV in patients with HOCM shown as squares and those without dynamic obstruction as circles. LVEDV = left ventricular end-diastolic volume; other abbreviations as in Figure 1.
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Figure 4 Untwisting Delay Versus VO
2max
Regression plot of the correlation between the delay in left ventricular untwisting (expressed as percent of systolic duration) and peak oxygen consumption (VO
2max) in patients with HOCM shown as squares and those without dynamic obstruction as circles. Abbreviations as in Figure 1.
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Figure 5 Examples of Global Strain and Twist Before and After Septal Ablation
Global strain before and after septal ablation. Improvement is present in longitudinal (A and B), radial (C and D), and circumferential (E and F) strain. Left ventricular twist before and after septal ablation (G and H). Twist is unchanged.
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Figure 6 Change in Untwisting Delay Versus Change in LVEDV
Regression plot of the correlation between the change in LV untwisting (expressed as percent of systolic duration) after septal reduction procedures and the change in LVEDV in the 16 patients with HOCM who underwent myectomy or septal ablation by ethanol. Abbreviations as in Figures 1 to 3.
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Figure 7 Change in Untwisting Delay Versus Change in VO2max
Regression plot of the correlation between the change in left ventricular untwisting (expressed as percent of systolic duration) after septal reduction procedures and the change in peak VO
2 in the 16 patients with HOCM who underwent myectomy or septal ablation by ethanol. Abbreviations as in Figures 1 and 4.
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