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Hypertrophic cardiomyopathy (HCM) has diverse manifestations, including variable symptoms attributable to left-ventricular outflow tract (LVOT) obstruction. Much of the literature characterizing HCM and its associated dynamic LVOT obstruction has been based upon assessments at rest rather than during provocation.
These investigators studied 320 patients seen, at one of three referral centers, for HCM with nondilated hypertrophied left ventricles without an identifiable cause (e.g., hypertension). The 201 patients whose resting LVOT gradients were less than 50 mm Hg underwent symptom-limited exercise testing with echocardiography. Patients with LVOT ≥50 mm Hg did not undergo exercise testing; they were older, had greater degrees of hypertroph…