Document Detail

Chronotropic incompetence and its relation to exercise intolerance in hypertrophic cardiomyopathy.
MedLine Citation:
PMID:  20851477     Owner:  NLM     Status:  In-Data-Review    
BACKGROUND: Diminished functional capacity is common in hypertrophic cardiomyopathy (HCM), although the underlying mechanisms are complicated. We studied the prevalence of chronotropic incompetence and its relation to exercise intolerance in patients with HCM.
METHODS: Cardiopulmonary exercise testing was performed in 68 patients with HCM (age 44.8±14.6years, 45 males). Chronotropic incompetence was defined by chronotropic index (heart rate reserve)/(220-age-resting heart rate) and exercise capacity was assessed by peak oxygen consumption (peak Vo(2)).
RESULTS: Chronotropic incompetence was present in 50% of the patients and was associated with higher NYHA class, history of atrial fibrillation, higher fibrosis burden on cardiac MRI, and treatment with β-blockers, amiodarone and warfarin. On univariate analysis, male gender, age, NYHA class, maximal wall thickness, left atrial diameter, peak early diastolic myocardial velocity of the lateral mitral annulus, history of atrial fibrillation, presence of left ventricular outflow tract obstruction (LVOTO) at rest, and treatment with beta-blockers were related to peak Vo(2). Peak heart rate during exercise, heart rate reserve, chronotropic index, and peak systolic blood pressure were also related to peak Vo(2). On multivariate analysis male gender, atrial fibrillation, presence of LVOTO and heart rate reserve were independent predictors of exercise capacity (R(2)=76.7%). A cutoff of 62bpm for the heart rate reserve showed a negative predictive value of 100% in predicting patients with a peak Vo(2) <80%.
CONCLUSIONS: Blunted heart rate response to exercise is common in HCM and represents an important determinant of exercise capacity.
Georgios K Efthimiadis; Georgios Giannakoulas; Despina G Parcharidou; Efstathios D Pagourelias; Evangelia J Kouidi; Georgios Spanos; Vasileios Kamperidis; Stavros Gavrielides; Haralambos Karvounis; Ioannis Styliadis; Georgios E Parcharidis
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Publication Detail:
Type:  Journal Article     Date:  2010-09-20
Journal Detail:
Title:  International journal of cardiology     Volume:  153     ISSN:  1874-1754     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-11-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  179-84     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
Cardiomyopathies Laboratory, First Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Greece.
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