Document Detail


Timing and significance of exercise-induced left ventricular outflow tract pressure gradients in hypertrophic cardiomyopathy.
MedLine Citation:
PMID:  21029828     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The relation of exercise-induced left ventricular (LV) outflow tract obstruction to functional capacity in hypertrophic cardiomyopathy (HC) is incompletely defined. Thus, we assessed the patterns of onset of physiologically provoked LV outflow gradients and exercise performance in 74 consecutive patients with HC (age 45 ± 16 years; 74% men) without LV outflow obstruction at rest. The subaortic gradients were measured serially using echocardiography in these 74 patients during maximum, symptom-limited, upright bicycle exercise testing. The time course of the provoked gradients and the relation to exercise performance were assessed. Of the 74 patients, 30 (41%) developed a dynamic LV outflow gradient of ≥30 mm Hg (mean 78 ± 37 mm Hg) during upright exercise testing that correlated highly with the gradients measured with the patients supine during the immediate recovery period (R² = 0.97). The 16 patients in whom outflow obstruction developed rapidly at low exercise levels (≤5 METs) had a significantly reduced exercise capacity (6.1 ± 1.3 vs 8.0 ± 1.6 METs; p <0.01) compared to the other 14 patients in whom obstruction appeared later at greater exercise levels of >5 METs. The timing of the gradient onset was not predictable from the baseline clinical and echocardiographic features, peak exercise LV outflow tract gradient, or symptoms. In conclusion, in patients with HC without outflow obstruction at rest, the earlier onset of LV outflow tract gradients during physiologic exercise was associated with impaired exercise performance. These findings have provided insights into the determinants of functional impairment in HC and support the potential value of exercise echocardiography in the clinical assessment of patients with HC.
Authors:
Stefano Nistri; Iacopo Olivotto; Martin S Maron; Camilla Grifoni; Katia Baldini; Massimo Baldi; Aurelio Sgalambro; Franco Cecchi; Barry J Maron
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-09-21
Journal Detail:
Title:  The American journal of cardiology     Volume:  106     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-10-29     Completed Date:  2010-12-02     Revised Date:  2011-05-02    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1301-6     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 Elsevier Inc. All rights reserved.
Affiliation:
CMSR-Veneto Medica, Altavilla Vicentina, Italy. snistr@tin.it
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MeSH Terms
Descriptor/Qualifier:
Adult
Analysis of Variance
Cardiomyopathy, Hypertrophic / physiopathology*,  ultrasonography
Chi-Square Distribution
Echocardiography
Exercise Test
Female
Humans
Logistic Models
Male
Middle Aged
Posture
Ventricular Outflow Obstruction / physiopathology*,  ultrasonography
Ventricular Pressure
Comments/Corrections
Comment In:
Am J Cardiol. 2011 Apr 1;107(7):1101-2; author reply 1102   [PMID:  21419892 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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