Document Detail

Rest and latent obstruction in hypertrophic cardiomyopathy: impact on exercise tolerance.
MedLine Citation:
PMID:  22728835     Owner:  NLM     Status:  Publisher    
AIMS: Most patients with hypertrophic cardiomyopathy (HCM) show a limited exercise capacity. A correlation between exercise tolerance and diastolic dysfunction has already been demonstrated. On the contrary, the role of rest-induced or exercise-induced obstruction as a determinant of exercise capacity is still open to debate. The aim of the present study was to analyse the exertional behaviour of patients with HCM presenting different left ventricle (LV) obstructive profiles. METHODS: Thirty-five consecutive patients with HCM (mean age 45 ± 14 years, 23 men) underwent echocardiography during cardiopulmonary exercise (CPX) testing. Non-invasive measurement of cardiac output was obtained with an inert gas rebreathing system at the beginning and at peak of exercise. RESULTS: Fifteen patients (43%) had neither resting nor provocable obstruction (group A: non-obstructive profile), 12 patients (34%) showed provocable obstruction during exercise (group B: latent-obstructive profile) and eight patients (23%) presented obstruction at rest (group C: rest-obstructive profile). Group A and B patients showed higher peak oxygen consumption in comparison with group C patients (24 ± 6 and 23 ± 6 vs. 17 ± 3 ml/kg per min; P = 0.016) and a greater increment of cardiac index during exercise (6.6 ± 1.3 and 6.0 ± 1.4 vs. 4.6 ± 0.8 l/min per m; P = 0.004). CONCLUSION: In comparison with the rest-obstructive profile, latent and non-obstructive HCM patients seem to share a similar exertional behaviour characterized by a greater increment of cardiac index during exercise and a minor impairment of exercise tolerance. Accordingly, in HCM patients not obstructive at rest, latent obstruction cannot be suspected based on exertional behaviour and functional capacity. Echocardiography performed during CPX test providing an important adjunct, may be valuable in guiding treatment in patients with substantial exercise limitation.
Federica Re; Elisabetta Zachara; Andrea Avella; Pasquale Baratta; Michele Di Mauro; Maria Penco; Francesco Musumeci; Claudio Tondo
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-6-21
Journal Detail:
Title:  Journal of cardiovascular medicine (Hagerstown, Md.)     Volume:  -     ISSN:  1558-2035     ISO Abbreviation:  -     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-6-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101259752     Medline TA:  J Cardiovasc Med (Hagerstown)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
aCardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, St. Camillo-Forlanini Hospital, Rome bCardiology, University of L'Aquila, Coppito cCardiac Surgery and Transplantation Center, St. Camillo-Forlanini Hospital, Rome dCentro Cardiologico, Monzino IRCCS, Milan, Italy.
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