OBJECTIVES: We sought to identify the pattern of disturbed left ventricular physiology associated with symptom development in elderly @entity1 with effort-induced @entity1353 . BACKGROUND: Limitation of exercise tolerance by @entity1353 is common in the elderly and has been ascribed to @entity67 when left ventricular cavity size and systolic function appear normal. METHODS: @entity452 stress echocardiography was used in 30 @entity1 (mean [+/-SD] age 70 +/- 12 years; 21 @entity1 , 9 @entity1 ) with exertional @entity1353 and negative exercise test results, and the values were compared with those in 15 control subjects. RESULTS: Before stress, left ventricular end-diastolic and end-systolic dimensions were reduced, fractional shortening was increased, and the basal septum was thickened (2.3 +/- 0.5 vs. 1.4 +/- 0.2 cm, p < 0.001, vs. control subjects) in the @entity1 , but posterior wall thickness did not differ from that in control subjects. Left ventricular outflow tract diameter, measured as systolic mitral leaflet septal distance, was significantly reduced (13 +/- 4.5 vs. 18 +/- 2 mm, p < 0.001). Isovolumetric relaxation time was prolonged, and peak left ventricular minor axis lengthening rate was reduced (8.1 +/- 3.5 vs. 10.4 +/- 2.6 cm/s, p < 0.05), suggesting @entity67 . Transmitral velocities and the E/A ratio did not differ significantly. At peak stress, heart rate increased from 66 +/- 8 to 115 +/- 20 beats/min in the control subjects, but blood pressure did not change. Transmitral A wave velocity increased, but the E/A ratio did not change. Left ventricular outflow tract velocity increased from 0.8 +/- 0.1 to 2.0 +/- 0.2 m/s, and mitral leaflet septal distance decreased from 18 +/- 2 to 14 +/- 3 mm, p < 0.001. In the @entity1 , heart rate rose from 80 +/- 12 to 132 +/- 26 beats/min and systolic blood pressure from 143 +/- 22 to 170 +/- 14 mm Hg (p < 0.001 for each), but left ventricular dimensions did not change. Peak left ventricular outflow tract velocity increased from 1.5 +/- 0.5 m/s (at rest) to 4.2 +/- 1.2 m/s; mitral leaflet septal distance fell from 13 +/- 4.5 to 2.2 +/- 1.9 mm (p < 0.001); and systolic anterior motion of mitral valve appeared in 24 @entity1 (80%) but in none of the control subjects (p < 0.001). Measurements of diastolic function did not change. All @entity1 developed @entity1353 at peak stress, but none developed a new wall motion abnormality or @entity339 . CONCLUSIONS: Although our @entity1 fulfilled the criteria for " @entity712 ," @entity67 was not aggravated by pharmacologic stress. Instead, high velocities appeared in the left ventricular outflow tract and were associated with @entity1184 and systolic anterior motion of the mitral valve. Their appearance correlated closely with the development of symptoms, suggesting a potential causative link.

Stress-induced left ventricular outflow tract obstruction: a potential cause of XXXX in the elderly.

@entity1 :: ('9606', 'Species') :: ['women', 'patients', 'men'] @entity712 :: ('MESH:D006333', 'Disease') :: ['diastolic heart failure'] @entity339 :: ('MESH:D008944', 'Disease') :: ['mitral regurgitation'] @entity452 :: ('MESH:D004280', 'Chemical') :: ['Dobutamine'] @entity1353 :: ('MESH:D004417', 'Disease') :: ['breathlessness', 'dyspnea'] @entity1184 :: ('MESH:D006984', 'Disease') :: ['basal septal hypertrophy'] @entity67 :: ('MESH:D018754', 'Disease') :: ['diastolic dysfunction']
@entity1353 :: (MESH:D004417,Disease) :: ['dyspnea']
