Improvement in Hypertrophic Cardiomyopathy After Significant Weight Loss: Case Report

Gabriel I. Uwaifo, MD, Erica M. Fallon, BS, Karim A. Calis, PharMD, MPh, Bart Drinkard, PT, MSPT, CCS, Jennifer R. McDuffie, PhD, Jack A. Yanovski, MD, PhD


South Med J. 2003;96(6) 

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The patient lost a large amount of weight (49 kg) ( Table 1 ), with concomitant reductions in body mass index and body fat measured on dual-energy x-ray absorptiometric scans (Hologic QDR 4500A; Hologic, Inc., Bedford, MA) obtained during the study period. Cardiovascular vital signs obtained during the first month of treatment were also significantly improved compared with those obtained 1 year later ( Table 1 ). The patient had Stage 1 isolated systolic hypertension according to Joint National Committee VI criteria at the start of the program, but this condition resolved by the end of the study period.

The baseline echocardiogram showed a nondilated hyperdynamic left ventricle with asymmetric left ventricular hypertrophy, no systolic anterior motion of the mitral valve, hypertrophy restricted to the left ventricular apex, and midventricular apposition of the septum with papillary muscles and free wall. There was also color Doppler sonographic evidence of mild mitral and tricuspid regurgitation. These findings were noted to be virtually pathognomonic of familial hypertrophic cardiomyopathy.[10] The echocardiogram obtained at the 1-year follow-up examination showed essentially similar observations, with changed dimensions. The cardiac dimensions, echocardiographic derived mass, volume and functional indices, and color Doppler flow measurements obtained from both studies are shown in Table 2 . Whether computed on the basis of the thin model or the thick model, and whether indexed by body surface area (LVMI) or by height (LVMIH), there was a clinically significant reduction in the LVM. In addition, the left ventricular internal and external volumes and the left ventricular myocardial volume were reduced significantly. The ratio of left ventricular internal to external volumes was found to be reduced significantly compared with established norms for hypertensive patients (0.85 ± 0.02), consistent with the patient's hypertrophic cardiomyopathy and an associated restrictive cardiopathic pattern.


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