Abstract
BackgroundThe development of intra-ventricular gradients (IVG) during dobutamine or exercise stress is not infrequent, and can be associated to symptoms during stress.The purpose of this study was to assess the occurrence of IVG during exercise stress echocardiography in cardiac syndrome X patients.MethodsWe prospectively evaluated 91 patients (pts) mean aged 51 ± 12 years (age ranged 20 to 75 years old), 44 of whom were women. All pts had angina, positive exercise ECG treadmill testing, normal rest echocardiogram and no coronary artery disease on coronary angiogram (cardiac X syndrome). After complete Doppler echocardiographic evaluation with determination of left ventricular outflow tract index (LVOTi), relative left ventricular wall thickness (RLVWT) and left ventricular end-diastolic volume index (LVDVi), all patients underwent stress echocardiography with two-dimensional and Doppler echographic evaluation during and after treadmill exercise.ResultsFor analysis purpose patients were divided in 2 groups, according to the development of IVG. Doppler evidence of IVG was found in 33 (36%) of the patients (Group A), with mean age 47 ± 14 years old (age ranged 20 to 72 years) and with a mean end-systolic peak gradient of 86 ± 34 mmHg (ranging from 30 to 165 mmHg). The IVG development was accompanied by SAM of the mitral valve in 23 pts. Three of these pts experienced symptomatic hypotension. Ten were women (30% pts). 58 pts in group B, 34 of whom were women (59%) (p = 0,01 vs group A), mean aged 53,5 ± 10,9 years old (age ranged 34 to 75 years) (p = 0,03 vs group A), did not develop IVG. LVOTi was 10,29 ± 0,9 mm/m2 in group A and 11,4 ± 1 mm/m2 in group B (p < 0,000); RLVWT was 0,36 ± 0,068 in group A and 0,33 ± 0,046 in group B (p < 0,01); LVDVi was 44,8 ± 10 ml/m2 in group A and 56 ± 11,6 ml/m2 in group B (p = 0,000).Conclusion1. A significant number of patients with cardiac X syndrome developed IVG during upright exercise in treadmill. These pts (group A) are mainly males and younger than those who did not develop IVG.2. The development of IVG and mitral valve SAM on exertion seems to be associated with ST segment downsloping during stress testing in patients without epicardial coronary disease.3. The development of IVG and mitral valve SAM seems to be associated with lower LVOTi, lower LVDVi and higher RLVWT.
Highlights
IntroductionThe development of intra-ventricular gradients (IVG) during dobutamine or exercise stress is not infrequent, and can be associated to symptoms during stress
The development of intra-ventricular gradients (IVG) during dobutamine or exercise stress is not infrequent, and can be associated to symptoms during stress.The purpose of this study was to assess the occurrence of IVG during exercise stress echocardiography in cardiac syndrome X patients
The development of IVG and mitral valve systolic anterior movement of mitral valve (SAM) on exertion seems to be associated with ST segment downsloping during stress testing in patients without epicardial coronary disease
Summary
The development of intra-ventricular gradients (IVG) during dobutamine or exercise stress is not infrequent, and can be associated to symptoms during stress. The purpose of this study was to assess the occurrence of IVG during exercise stress echocardiography in cardiac syndrome X patients. The development of IVG during DSE has been largely reported and this fact is commonly associated with symptoms during the stress study [1,2]. In a 23 years old male, with a positive treadmill test, a structural normal heart, normal coronary angiographies, an ESE was performed and during the study we unexpectedly detect a 102 mmHg intra-ventricular gradient [5] and systolic anterior movement of mitral valve (SAM). The aim of this study was to present the results of search for intra-ventricular gradients during exercise stress echocardiography in patients with angina, positive stress electrocardiography, normal coronary arteries, and normal echocardiogram (cardiac X syndrome)
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