arrhythmia cardiomyopathy

takotsubo cardiomyopathy

Journal of Thoracic and Cardiovascular Surgery

Central MessageLow resting gradients in patients suspected of outflow tract obstruction should not breed complacency. Provocative measures can reveal significant obstruction that is amenable to surgical relief.See Article page 1863. Low resting gradients in patients suspected of outflow tract obstruction should not breed complacency. Provocative measures can reveal significant obstruction that is amenable to surgical relief. See Article page 1863. Biologic latency is defined as something that is hidden until circumstances are suitable for development or manifestation. Inherent to latency is the fact that a disease can be difficult to diagnosis, often leading to a long period before implementing appropriate treatment. In their report published in this issue of the Journal, investigators at the Mayo Clinic leverage their historical infrastructure and experience related to hypertrophic obstructive cardiomyopathy (HOCM) to examine a sneaky subpopulation of patients with latent left ventricular outflow track obstruction (LVOT).1Cui H. Schaff H.V. Nishimura R.A. Dearani J.A. Geske J.B. Ommen S.R. Latent outflow tract obstruction in hypertrophic cardiomyopathy: clinical characteristics and outcomes of septal myectomy.J Thorac Cardiovasc Surg. 2022; 164: 1863-1869.e1Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar One of the many take-home messages is that the physician/surgeon has to look for latent HOCM–it is dormant, like the word says. When evaluating patients with ongoing symptoms, one should not be complacent about a low resting LVOT gradient. Lying flat on a table is not when these patients have trouble. Using a series of well-protocolized provocative maneuvers by echocardiography (Valsalva, amyl nitrate), catheterization (isoproterenol infusion), and intraoperatively (inducible premature ventricular contractions, isoproterenol infusion), they demonstrate that low gradients can dramatically increase, not just beyond the defined cutoff of 30 mm Hg, but with some as high as 200 mm Hg. Importantly, t...

Commentary: Latent hypertrophic obstructive cardiomyopathy—(un)clear and present danger