Sitting maneuver to uncover latent left ventricular outflow tract obstruction in patients without hypertrophic cardiomyopathy

• Published in: Journal of cardiology Vol. 83; no. 6; pp. 401 - 406
• Main Authors: Sekine, Ayako, Watanabe, Takatomo, Nakabo, Ayumi, Ichiryu, Hajime, Endo, Susumu, Hayashi, Misayo, Naruse, Genki, Nakayama, Juri, Takada, Ayae, Fujimoto, Shingo, Ozawa, Noriko, Inada, Takayuki, Nohisa, Yuzuru, Kikuchi, Ryosuke, Kanamori, Hiromitsu, Okura, Hiroyuki
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-06-2024
• Subjects: Aged; Aged, 80 and over; Cardiomyopathy; Cardiomyopathy, Hypertrophic; Doppler; Echocardiography; Humans; Left ventricular outflow obstruction; Sitting Position; Valsalva Maneuver; Ventricular Outflow Obstruction - diagnostic imaging; Ventricular Outflow Obstruction - etiology; Ventricular Outflow Obstruction, Left; Left ventricular outflow obstruction; Echocardiography; Cardiomyopathy; Doppler
• ISSN: 0914-5087; 1876-4738; 1876-4738
• DOI: 10.1016/j.jjcc.2023.11.006

Left ventricular outflow tract obstruction [LVOTO; pressure gradient (PG) ≥30 mmHg] is observed in some patients without hypertrophic cardiomyopathy (HCM), and it may develop especially in older patients without HCM (non-HCM). The aim of this study is to investigate if the Valsalva or an upright sitting maneuver can unveil latent LVOTO in patients with non-HCM.
A total of 33 non-HCM patients with a late peaking or dagger-shaped pulsed Doppler waveform of the LVOT and PG <30 mmHg were included. The Doppler flow velocity of the LVOT was measured at rest, after the Valsalva and a sitting maneuver. Peak PG of ≥30 mmHg after either maneuver was defined as latent LVOTO. The angle between the left ventricular septum and the aorta in the parasternal long-axis view and the apical three-chamber view was measured.
Twenty (61 %) of the 33 patients (mean age 74 ± 9 years) were diagnosed with latent LVOTO. Of these, five (25 %) patients were diagnosed after both the Valsalva and sitting maneuver, and 15 (75 %) were diagnosed only after the sitting maneuver. The latent LVOTO group had a significantly smaller angle than the no-LVOTO group between the ventricular septum and the aorta in the parasternal long axis views (107 ± 8° vs. 117 ± 8°, p < 0.01).
The sitting maneuver is better than the Valsalva maneuver in unveiling latent LVOTO in older, non-HCM patients.
[Display omitted]
•Sitting maneuver could induce left ventricular outflow tract obstruction (LVOTO) better than the Valsalva maneuver.•Sitting maneuver is useful to unveil latent LVOTO in non-HCM population.•We should pay special attention to the presence of latent LVOTO when we found a sigmoid septum and a small LVDd.•It should be adopted as an additional maneuver to uncover latent LVOTO.