Effects of Moderate Spine Exercise or Diet on Hemodynamics in Patients with Hypertrophic Obstructive Cardiomyopathy and Aortic Stenosis

抄録

Left ventricular outflow tract stenosis is present in patients with hypertrophic cardiomyopathy; however, this is a dynamic change, and the pressure gradient changes easily. We aimed to compare the hemodynamic effects of moderate exercise or diet in hypertrophic obstructive cardiomyopathy with dynamically changing obstruction and aortic stenosis with fixed stenosis. We included 14 hypertrophic obstructive cardiomyopathy patients with a left ventricular outflow tract continuous-wave Doppler pressure gradient of ≥ 30 mmHg on fasting or postprandial condition and eight aortic stenosis with pressure gradient of ≥ 20 mmHg. Echocardiographic examinations were performed during fasting, passive leg raising, 5 min of exercise, early and late recovery periods, and 30 min after meals. The pressure gradient in patients with aortic stenosis increased during passive lower extremity elevation, causing increased preload pressure, but that at the left ventricular outflow tract stenosis in hypertrophic obstructive cardiomyopathy decreased. The pressure gradient in hypertrophic obstructive cardiomyopathy did not change during supine exercise but increased rapidly after exercise and slowly recovered thereafter. A diet with decreased afterload slightly increased the pressure gradient in patients with aortic stenosis and significantly increased left ventricular outflow tract stenosis in patients with hypertrophic obstructive cardiomyopathy. Left ventricular outflow tract-pressure gradient in hypertrophic obstructive cardiomyopathy fluctuates dynamically with daily exercise and diet. The left ventricular outflow tract-pressure gradient increases immediately after exercise; therefore, it is important to encourage drinking before exercise and instruct patients to cool down at the end of exercise. Exercise after eating should be avoided in patients with hypertrophic obstructive cardiomyopathy.