Contemporary Natural History and Management of ...

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY ? 2016 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION PUBLISHED BY ELSEVIER

VOL. 67, NO. 12, 2016 ISSN 0735-1097/$36.00

Contemporary Natural History and Management of Nonobstructive Hypertrophic Cardiomyopathy

Martin S. Maron, MD,a Ethan J. Rowin, MD,a Iacopo Olivotto, MD,b Susan A. Casey, RN,c Anna Arretini, MD,b Benedetta Tomberli, MD,b Ross F. Garberich, MS,c Mark S. Link, MD,a Raymond H.M. Chan, MD,d John R. Lesser, MD,c Barry J. Maron, MDc

ABSTRACT

BACKGROUND Left ventricular outflow tract gradients are absent in an important proportion of patients with hypertrophic cardiomyopathy (HCM). However, the natural course of this important patient subgroup remains largely unresolved.

OBJECTIVES The authors systematically employed exercise (stress) echocardiography to define those patients without obstruction to left ventricular outflow at rest and/or under physiological exercise and to examine their natural history and clinical course to create a more robust understanding of this complex disease.

METHODS We prospectively studied 573 consecutive HCM patients in 3 centers (44 ? 17 years; 66% male) with New York Heart Association functional class I/II symptoms at study entry, including 249 in whom left ventricular outflow tract obstruction was absent both at rest and following physiological exercise ( ................
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