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Exercise hemodynamics in hypertrophic cardiomyopathy identify risk of incident heart failure but not ventricular arrhythmias or sudden cardiac death
- Source :
- International Journal of Cardiology. 274:226-231
- Publication Year :
- 2019
- Publisher :
- Elsevier BV, 2019.
-
Abstract
- To determine whether abnormal blood pressure response (ABPR), with or without left ventricular outflow tract obstruction (LVOTO), is associated with adverse heart failure and arrhythmia outcomes in hypertrophic cardiomyopathy (HCM).A retrospective, single-center analysis was performed for adult HCM patients who underwent exercise stress testing.Of 589 patients included in the study, 192 (33%) demonstrated ABPR. A similar proportion of patients with ABPR had LVOTO compared to those without ABPR (56% vs 63%, p = 0.11). Patients with ABPR demonstrated lower percent predicted VO2 and METs achieved than those with LVOTO (16.9 ± 6.8 vs 21.6 ± 7.9, p = 0.002 and 5.3 ± 2.4 vs 7.4 ± 3.1, p 0.001). In a subgroup of 17 patients with LVOTO and ABPR who subsequently underwent successful myectomy, 5 (30%) demonstrated persistent ABPR. 23 patients (3.8%) experienced sudden cardiac death or ventricular arrhythmias, which were not associated with ABPR, regardless of age group. In multivariable analysis, syncope (p = 0.04), left ventricular hypertrophy (p = 0.02) and left atrial diameter (p = 0.006) were significantly associated with the composite outcome of sudden death or severe ventricular arrhythmia, whereas ABPR was not (p = 0.38). In contrast, ABPR was associated with subsequent heart failure hospitalization (p = 0.002), regardless of presence or absence of LVOTO (p = 0.04, p = 0.02).ABPR is associated with reduced functional capacity in HCM regardless of the presence of LVOTO but is not associated with adverse arrhythmia outcomes. Patients with ABPR have a higher incidence of subsequent heart failure hospitalization.
- Subjects :
- Adult
Male
Exercise stress testing
medicine.medical_specialty
Heart Ventricles
Magnetic Resonance Imaging, Cine
Ventricular outflow tract obstruction
Exercise hemodynamics
030204 cardiovascular system & hematology
Sudden cardiac death
03 medical and health sciences
0302 clinical medicine
Risk Factors
Internal medicine
medicine
Humans
cardiovascular diseases
030212 general & internal medicine
Retrospective Studies
Heart Failure
Exercise Tolerance
business.industry
Incidence (epidemiology)
Hemodynamics
Hypertrophic cardiomyopathy
Cardiomyopathy, Hypertrophic
Middle Aged
Prognosis
medicine.disease
Death, Sudden, Cardiac
Blood pressure
Heart failure
Exercise Test
Tachycardia, Ventricular
Cardiology
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Follow-Up Studies
Subjects
Details
- ISSN :
- 01675273
- Volume :
- 274
- Database :
- OpenAIRE
- Journal :
- International Journal of Cardiology
- Accession number :
- edsair.doi.dedup.....1ec525b83728775aba7c0a929f2cceb2