|Relation of left ventricular chamber stiffness at rest to exercise capacity in hypertrophic cardiomyopathy.|
|PMID: 17493479 Owner: NLM Status: MEDLINE|
|The degree of exercise capacity is poorly predicted by conventional markers of disease severity in patients with hypertrophic cardiomyopathy (HC). The principal mechanism of exercise intolerance in patients with HC is the failure of stroke volume augmentation due to left ventricular (LV) diastolic dysfunction. The role of LV chamber stiffness, assessed noninvasively, as a determinant of exercise tolerance is unknown. Sixty-four patients with HC were studied with Doppler echocardiography, exercise testing, and gadolinium cardiac magnetic resonance. The LV chamber stiffness index was determined as the ratio of pulmonary capillary wedge pressure (derived from the E/Ea ratio) to LV end-diastolic volume (assessed by cardiac magnetic resonance). Maximal exercise tolerance was defined as achieved METs. There were inverse correlations between METs achieved and age (r = -0.38, p = 0.003), heart rate deficit (r = -0.39, p = 0.002), LV outflow tract gradient (r = -0.33, p = 0.009), the E/Ea ratio (r = -0.4, p = 0.001), mean LV wall thickness (r = -0.26, p = 0.04), and LV stiffness (r = -0.56, p <0.001) and a positive correlation between METs achieved and LV end-diastolic volume (r = 0.33, p = 0.01). On multivariate analysis, only LV chamber stiffness was associated with exercise capacity. A LV stiffness level of 0.18 mm Hg/ml had 100% sensitivity and 75% specificity (area under the curve 0.84) for predicting < or =7 METs achieved. In conclusion, LV diastolic dysfunction at rest, as manifested by increased LV chamber stiffness, is a major determinant of maximal exercise capacity in patients with HC.|
|Carlos Alberto Dumont; Lorenzo Monserrat; Jesús Peteiro; Rafaela Soler; Esther Rodriguez; Alberto Bouzas; Xusto Fernández; Ruth Pérez; Beatriz Bouzas; Alfonso Castro-Beiras|
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|Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2007-04-04|
|Title: The American journal of cardiology Volume: 99 ISSN: 0002-9149 ISO Abbreviation: Am. J. Cardiol. Publication Date: 2007 May|
|Created Date: 2007-05-11 Completed Date: 2007-08-02 Revised Date: -|
Medline Journal Info:
|Nlm Unique ID: 0207277 Medline TA: Am J Cardiol Country: United States|
|Languages: eng Pagination: 1454-7 Citation Subset: AIM; IM|
|Cardiology Division, Juan Canalejo Hospital, A Coruña, Spain.|
|APA/MLA Format Download EndNote Download BibTex|
Analysis of Variance
Cardiomyopathy, Hypertrophic / diagnosis, etiology, physiopathology*
Echocardiography, Doppler, Color
Gadolinium DTPA / diagnostic use
Hypertrophy, Left Ventricular / complications, diagnosis, physiopathology*
Magnetic Resonance Imaging, Cine
Pulmonary Wedge Pressure
Sensitivity and Specificity
Severity of Illness Index
Ventricular Dysfunction, Left / complications, diagnosis, physiopathology*
|0/Contrast Media; 80529-93-7/Gadolinium DTPA|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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