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Peer-reviewedCC BY-NC-ND 4.0JACC Case Reports

Unmasking Latent Left Ventricular Outflow Tract Obstruction in Hypertrophic Cardiomyopathy

  • Hyunseok Cho1
  • Jihoon Kim1
  • Sang-Chol Lee1
  • Ki Hong Choi1
  • Jeong Hoon Yang2
  1. 1Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
  2. 2Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Abstract

Background: Dynamic left ventricular outflow tract (LVOT) obstruction in hypertrophic cardiomyopathy may be missed on resting echocardiography, and it requires provocation for detection.

Case Summary: A 41-year-old man with previously classified nonobstructive hypertrophic cardiomyopathy presented with recurrent syncope. Serial echocardiography had demonstrated no significant dynamic LVOT obstruction. During reassessment, repeated Doppler interrogation with Valsalva maneuver revealed variable pressure gradients ranging from 25 to 46 mm Hg. Exercise stress echocardiography further unmasked severe LVOT obstruction, with a peak gradient of 108 mm Hg and worsening mitral regurgitation. Multimodality assessment, including postextrasystolic provocation and invasive hemodynamics, demonstrated comparable augmentation of LVOT gradients. Mavacamten therapy eliminated LVOT obstruction, with no recurrence of syncope.

Discussion: Exercise-induced gradients paralleled those obtained with mechanistic provocation, indicating that physiologic stress can reliably reflect the magnitude of latent obstruction.

Take-Home Message: Exercise stress echocardiography, supported by complementary provocation, may provide a practical approach to identify clinically significant latent LVOT obstruction.

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Cite

BibTeXRIS
BibTeX
@article{cho2026unmasking,
  title = {{Unmasking Latent Left Ventricular Outflow Tract Obstruction in Hypertrophic Cardiomyopathy}},
  author = {Hyunseok Cho and Jihoon Kim and Sang-Chol Lee and Ki Hong Choi and Jeong Hoon Yang},
  journal = {JACC Case Reports},
  year = {2026},
  month = aug,
  doi = {10.1016/j.jaccas.2026.109898},
  url = {https://doi.org/10.1016/j.jaccas.2026.109898},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Unmasking Latent Left Ventricular Outflow Tract Obstruction in Hypertrophic Cardiomyopathy
AU  - Hyunseok Cho
AU  - Jihoon Kim
AU  - Sang-Chol Lee
AU  - Ki Hong Choi
AU  - Jeong Hoon Yang
PY  - 2026
DA  - 2026/08/22
JO  - JACC Case Reports
DO  - 10.1016/j.jaccas.2026.109898
UR  - https://doi.org/10.1016/j.jaccas.2026.109898
AB  - Background: Dynamic left ventricular outflow tract (LVOT) obstruction in hypertrophic cardiomyopathy may be missed on resting echocardiography, and it requires provocation for detection.  Case Summary: A 41-year-old man with previously classified nonobstructive hypertrophic cardiomyopathy presented with recurrent syncope. Serial echocardiography had demonstrated no significant dynamic LVOT obstruction. During reassessment, repeated Doppler interrogation with Valsalva maneuver revealed variable pressure gradients ranging from 25 to 46 mm Hg. Exercise stress echocardiography further unmasked severe LVOT obstruction, with a peak gradient of 108 mm Hg and worsening mitral regurgitation. Multimodality assessment, including postextrasystolic provocation and invasive hemodynamics, demonstrated comparable augmentation of LVOT gradients. Mavacamten therapy eliminated LVOT obstruction, with no recurrence of syncope.  Discussion: Exercise-induced gradients paralleled those obtained with mechanistic provocation, indicating that physiologic stress can reliably reflect the magnitude of latent obstruction.  Take-Home Message: Exercise stress echocardiography, supported by complementary provocation, may provide a practical approach to identify clinically significant latent LVOT obstruction.
SN  - 2666-0849
ER  -