New Concepts in Hypertrophic Cardiomyopathies
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To the Editor:
We found the excellent review, “New concepts in hypertrophic cardiomyopathies,”1,2⇓ very stimulating, although in our opinion, one issue needs further clarification in light of existing evidence in the literature (or lack thereof). The authors state (page 2249, first paragraph) that “because the LVOT [left ventricular outflow tract] obstruction is dynamic, patients in whom the disease is suspected and who do not have a gradient at rest should undergo provocation maneuvers with agents such as dobutamine to determine the severity of the gradient.”2
Dobutamine-induced gradients are common in hypertrophic cardiomyopathy (HCM)3–5⇓⇓ as well as in other cardiac conditions.6 To our knowledge, however, no convincing evidence exists that dobutamine echocardiography provides reliable pathophysiological or prognostic information in patients with HCM. In …