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The evolution of basal septal hypertrophy: From benign and age‐related normal variant to potentially obstructive and symptomatic cardiomyopathy
Author(s) -
Pearson Anthony C.
Publication year - 2017
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13588
Subject(s) - medicine , ventricular outflow tract obstruction , cardiology , hypertrophic cardiomyopathy , basal (medicine) , inotrope , cardiomyopathy , muscle hypertrophy , heart failure , insulin
Localized thickening of the basal portion of the ventricular septum or basal septal hypertrophy ( BSH ) has been identified both at autopsy and by imaging studies for decades; despite numerous investigations, there is no consensus on the significance of this finding and a remarkable lack of consistency in terminology. This paper summarizes the scientific literature on the topic, focusing on recent echocardiographic findings. A case description illustrating some of the complex issues involved in measurement and diagnosis and differentiation from sigmoidal hypertrophic cardiomyopathy ( HCM ) is presented. Criteria are proposed for diagnosing pathologic BSH which include the following: (1) Exertional symptoms compatible with left ventricular outflow tract obstruction ( LVOTO ) such as dyspnea, near‐syncope, and chest discomfort; (2) Documented LVOTO gradient demonstrated at peak bicycle or post‐treadmill exercise >30 mm Hg; and (3) Symptomatic improvement with β‐blocker (or other negative inotropic) therapy (preferably accompanied by documentation of reduction of exercise‐induced LVOT ).