RESUMO
BACKGROUND: Left ventricular outflow tract obstruction [LVOTO; pressure gradient (PG) ≥30â¯mmHg] is observed in some patients without hypertrophic cardiomyopathy (HCM), and it may develop especially in older patients without HCM (non-HCM). The aim of this study is to investigate if the Valsalva or an upright sitting maneuver can unveil latent LVOTO in patients with non-HCM. METHODS: A total of 33 non-HCM patients with a late peaking or dagger-shaped pulsed Doppler waveform of the LVOT and PG <30â¯mmHg were included. The Doppler flow velocity of the LVOT was measured at rest, after the Valsalva and a sitting maneuver. Peak PG of ≥30â¯mmHg after either maneuver was defined as latent LVOTO. The angle between the left ventricular septum and the aorta in the parasternal long-axis view and the apical three-chamber view was measured. RESULTS: Twenty (61â¯%) of the 33 patients (mean age 74⯱â¯9â¯years) were diagnosed with latent LVOTO. Of these, five (25â¯%) patients were diagnosed after both the Valsalva and sitting maneuver, and 15 (75â¯%) were diagnosed only after the sitting maneuver. The latent LVOTO group had a significantly smaller angle than the no-LVOTO group between the ventricular septum and the aorta in the parasternal long axis views (107⯱â¯8° vs. 117⯱â¯8°, pâ¯<â¯0.01). CONCLUSION: The sitting maneuver is better than the Valsalva maneuver in unveiling latent LVOTO in older, non-HCM patients.