[Diagnosis and treatment of hypertrophic cardiomyopathies]. / Aktuelle Diagnostik und Therapie hypertrophischer Kardiomyopathien.

Hypertrophic cardiomyopathy is the most common inherited disease of the heart with a prevalence of 0.2 %. One third of patients show no obstruction of the left ventricular outflow tract, whereas two third develop a significant gradient under resting conditions and/or on exertion. Angina pectoris, dyspnea, syncope, heart failure und atrial fibrillation are typical clinical features. Apart from ECG and echocardiography, holter ECG and exercise testing via ergospirometry should be routinely used to identify an adverse clinical course and potential risk factors. Cardiac MRI is a complementary and comprehensive imaging modality and further aids in risk stratification for sudden cardiac death and ICD-implantation for primary prophylaxis. Mainstay of conservative therapy are betablockers, and novel pharmacological approaches are to be expected in the near future. Symptomatic patients with outflow tract obstruction benefit from septum-reducting therapy either by surgical myectomy or catheter-based septum ablation (TASH/PTSMA) with ethanol injection.

Severe mitral valve regurgitation with fatal cardiogenic shock in a patient on long-term cabergoline treatment.

The use of ergoline dopamine agonists for treatment of Parkinson's disease has recently been associated with the development of valvular heart disease. We here report the case of a patient who revealed severe mitral valve regurgitation and refractory cardiogenic shock during treatment with cabergolin in the absence of other causes for valvular disease. To the best of our knowledge, such a rapid progression and ultimately fatal outcome has not been described yet. Our case reemphasizes that patients with long-term administration of ergolines should be closely monitored for valvular degeneration.

The value of contrast dobutamine stress echocardiography on detecting coronary artery disease in overweight and obese patients.

BACKGROUND: Dobutamine stress echocardiography (DSE) is an established method of detecting myocardial ischemia. Its diagnostic accuracy solely depends on wall motion assessment. Clear visibility of the left ventricular endocardium is essential for reliable assessment of a wall motion abnormality. However, incremental benefits of contrast DSE for the detection of coronary artery disease (CAD) have not been demonstrated in overweight or obese patients. OBJECTIVES: The purpose of the present study was to test the incremental benefits of contrast DSE in detecting CAD in overweight or obese patients. METHODS: Sixty-two overweight or obese patients (body mass index 26 kg/m(2) to 33 kg/m(2)) underwent DSE with or without contrast and coronary angiography. Contrast-enhanced images were achieved at rest and during peak DSE after administration of SonoVue (Bracco Diagnostics Inc, Italy) or Optison (Mallinckrodt, USA). The endocardial border resolution for each myocardial segment was graded as 0, 1 or 2. A total of 992 segments from 62 subjects were analyzed. The results of DSE with or without contrast were compared with the findings on angiography. RESULTS: The differences in the score grading between the two groups with or without contrast, at rest and during peak DSE were statistically significant (P<0.001). The sensitivity, specificity and accuracy of contrast DSE in detecting CAD, compared with the studies without contrast, were improved (82% versus 70%, 78% versus 67% and 81% versus 69%, respectively). CONCLUSIONS: SonoVue and Optison can enhance left ventricular endocardial border delineation in overweight or obese patients, optimizing the evaluation of wall motion both at rest and during peak stress. This increases the diagnostic value of DSE in detecting CAD.