122
￭ S-165 ￭
Diverse geometric changes related to dynamic LVOT obstruction without overt HCM
Cardiology Division, Gangnam Severance Hospital, Yonsei University College of Medicine
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Jung-Joon Cha, Hyemoon Chung, Ji Hyun Yoon, Jong-Youn Kim, Pil-Ki Min, Young Won Yoon, Byoung-Kwon Lee, Bum-Kee Hong, Se-Joong Rim, Hyuck Moon Kwon, Eui-Young Choi
Background: Dynamic left ventricular (LV) outflow tract (LVOT) obstruction (LVOTO) is not rarely observed in subjects without overt hypertrophic cardiomyopathy (HCM). However, its geometrical determinants and clinical implication have not been fully investigated. Method:
We analyzed echocardiographic images diagnosed as dynamic LVOTO with Valsalva maneuver from 2008 to 2012 in a single tertiary referral hospital. Dynamic LVOTO was defined as trans-LVOT peak pressure gradient (PG) higher than 30 mmHg at resting or provoked by Valsalva maneuver without fixed structural stenosis. Exclusion criteria were patients with classical HCM, acute myocardial infarction, stress induced cardiomyopathy, valvular heart disease and unstable hemodynamics which potentially induce transient-LVOTO. Results: Total 168 patients were studied. Mean age was 71±11 years and 98 were women. They were classified as “pure sigmoid septum” (n=75) defined as basal septal bulging but diastolic thickness less than 12 mm, “sigmoid septum with basal septal hypertrophy (≥12 mm)” (n=24), “prominent papillary muscle (PPM)”
(n=20), defined by visually big papillary muscle which occludes LV cavity during systole and “small LV cavity with concentric remodeling”
(n=49) groups. PPM group was younger, had higher S’, lower E/e’ and left atrial volume index than the others. However, resting and Valsalva-induced LVOT PG were not different. In all groups, higher peak trans-LVOT PG was related to higher basal septal thickness (BST), E/e’, right atrial pressure (RAP) and pulmonary arterial systolic pressure (PASP). In multivariate analysis, resting trans-LVOT PG was correlated to PASP (ß=0.230, p=0.005) after adjustment for E/e’, BST and RAP. Conclusion: Dynamic LVOTO developed from various geometric changes, among them PPM group has distinct characteristics suggesting different etiology. LVOTO relieving medication might potentially reduce pulmonary pressure in this group of patients.
￭ S-166 ￭
The Morphologic Pattern of Ruptured Plaque; Is Plaque Shoulder Frequently Ruptured Site?
1건양대학교병원 심혈관센터, 2안동성소병원 심혈관센터
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서영훈
1, 김기홍
1, 육형빈
1, 박요한
1, 이충섭
1, 송인걸
1, 박현웅
1, 김완호
2, 권택근
1, 배장호
1Background: Plaque rupture site and its clinical significance have not been well studied, although rupture is usually developed near plaque shoulder and it is frequently associated with acute coronary syndrome (ACS). Subjects and Methods: We evaluated 22 patients who had plaque rupture at the culprit lesion defined by VH-IVUS (virtual histology-intravascular ultrasound). The site of plaque rupture is divided by cross sectional view (center, shoulder, unclassified) and longitudinal view (proximal, middle, distal). We also evaluated the association between morphologic features of the ruptured plaque and clinical features. Results: By cross sectional view, there were 11 ruptured plaques (50.0%) at center of the lesion and 8 ruptured plaques (36.4%) were located at shoulder of the lesion. Plaque rupture was mainly located in proximal (72.7%) and middle (27.3%) site of the lesion by longitudinal view. Center-located ruptured plaque had larger plaque area (18.2±3.7 mm2 vs. 11.4±3.0 mm2, p<0.001), fibrous area (8.7±2.5 mm2 vs. 4.5±1.4 mm2, p=0.001), fibrofatty area (2.5±1.0 mm2 vs. 1.6±1.1 mm2, p=0.016) and plaque burden (74.0±8.3% vs. 63.5±10.2%, p=0.023) than shoulder-located ruptured plaque. But ruptured cavity area (2.3±1.5 mm2 vs. 1.2±0.6 mm2, p=0.119) and ACS (57.9% vs. 31.6%, p=0.165) were not different between two groups. Plaque rupture at proximal site of the lesion had less multivessel disease than another plaque rupture sites (20% vs. 75% vs. 75%, p=0.037). ACS (80% vs. 87.5% vs. 100%, p=0.611), plaque burden (73.7±6.7%
vs. 67.3±12.9% vs. 71.0±13.0, p=0.445), ruptured cavity area (2.1±1.3 mm2 vs. 1.3±0.7 mm2 vs. 2.2±1.8 mm2, p=0.119) and peak troponin level (15.5±10.8 ng/mL vs. 12.0±11.6 ng/mL vs. 11.5±13.0 ng/mL, p=0.760) were not different among the lesion site by longitudinal view. Conclusion:
Plaque rupture was mostly occurred in proximal & middle site of the plaque in patients with ACS. Plaque rupture was equally developed both in center and shoulder of the plaque. The site of plaque rupture did not affect clinical results significantly.
