Document Detail


Relation of left ventricular chamber stiffness at rest to exercise capacity in hypertrophic cardiomyopathy.
MedLine Citation:
PMID:  17493479     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-04-04
Journal Detail:
Title:  The American journal of cardiology     Volume:  99     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2007 May 
Date Detail:
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    
Other Details:
Languages:  eng     Pagination:  1454-7     Citation Subset:  AIM; IM    
Affiliation:
Cardiology Division, Juan Canalejo Hospital, A Coruña, Spain.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Age Factors
Aged
Analysis of Variance
Cardiomyopathy, Hypertrophic / diagnosis,  etiology,  physiopathology*
Contrast Media
Echocardiography, Doppler, Color
Exercise Test
Exercise Tolerance*
Female
Gadolinium DTPA / diagnostic use
Heart Rate
Humans
Hypertrophy, Left Ventricular / complications,  diagnosis,  physiopathology*
Magnetic Resonance Imaging, Cine
Male
Middle Aged
Pulmonary Wedge Pressure
Regression Analysis
Research Design
Rest*
Sensitivity and Specificity
Severity of Illness Index
Stroke Volume
Vascular Resistance*
Ventricular Dysfunction, Left / complications,  diagnosis,  physiopathology*
Chemical
Reg. No./Substance:
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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