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Hypertrophic cardiomyopathy (HCM), characterized by myocardial hypertrophy that is out of proportion with hemodynamic load, is associated with a dynamic pressure gradient in the subaortic area in about 25% of cases. Management of these cases often is aimed at reducing or eliminating the pressure gradient. To assess the prognostic value of left-ventricular outflow-tract (LVOT) obstruction in HCM, researchers followed 1101 consecutive HCM patients from the U.S. and Italy for a mean of 6.3 years. A baseline resting LVOT gradient of ≥30 mm Hg was considered obstructive (25% of patients).
Patients with LVOT obstruction were older, more often female, had more severe symptoms (NYHA class III-IV), and had thicker LV walls and larger left-atrial dime…