Comparison of sublingual isosorbide dinitrate and Valsalva maneuver for detection of obstruction in hypertrophic cardiomyopathy

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ZEMANEK David TOMASOV Pavol BĚLEHRAD Miloš HLADKÁ Katarína KOŠŤÁLOVÁ Jana KÁRA Tomáš VESELKA Josef

Rok publikování 2015
Druh Článek v odborném periodiku
Časopis / Zdroj Archives of Medical Science
Fakulta / Pracoviště MU

Lékařská fakulta

Citace
Doi http://dx.doi.org/10.5114/aoms.2015.47096
Obor Kardiovaskulární nemoci včetně kardiochirurgie
Klíčová slova hypertrophic cardiomyopathy; left ventricular outflow tract obstruction; nitrate; Valsalva maneuver
Popis Introduction: A left ventricular outflow tract (LVOT) obstruction assessment with a provoking test should be a routine part of the evaluation of patients with hypertrophic cardiomyopathy (HCM). The aim of this study was to compare the utility of the Valsalva maneuver (VM) and sublingual spray application of isosorbide dinitrate (ISDN) for detection of an obstruction. Material and methods: We prospectively evaluated 81 consecutive HCM patients without severe rest LVOT obstruction (defined as peak rest pressure gradient (PG) >= 50 mm Hg). We measured PG at rest, during the VM, after sublingual ISDN spray, and during the VM after ISDN. An obstruction was defined as a PG >= 30 mm Hg. Results: An obstruction was present in 15 patients (19%) at rest (median and interquartile range of PG 16 (7-26) mm Hg), in 38 patients (47%) during the VM (PG 28 (12-49) mm Hg), in 50 (62%) patients after ISDN (PG 50 (12-79) mm Hg), and in 55 patients (68%) during the VM after ISDN (PG 59 (20-87) mm Hg). The difference in occurrence of obstruction among different provoking tests was statistically significant for all comparisons (p < 0.001, except for the comparison of the ISDN test with the VM during ISDN, p = 0.025). Conclusions: The ISDN test and the VM are useful screening methods for the detection of an HCM obstruction. Although ISDN appears to be more precise than the VM, the best option is a combination of both methods, which maximizes inducement of LVOT obstruction in patients with HCM.

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