Background An attenuated heart rate recovery after exercise has been shown to be predictive of mortality. In prior studies, recovery heart rates were measured while patients were exercising lightly, that is, during a cool-down period. It is not known whether heart rate recovery predicts mortality when measured in the absence of a cool-down period or after accounting for left ventricular systolic function. Methods and Results We followed 5438 consecutive patients without a history of heart failure or valvular disease referred for exercise echocardiography for 3 years. Heart rate recovery was defined as the difference in heart rate between peak exercise and 1 minute later; a value ≤18 beats per minute was considered abnormal. Patients assumed the left lateral decubitus position after exercise. An abnormal heart rate recovery was present in 805 patients (15%); during follow-up, 190 died. An abnormal heart rate recovery was predictive of death (9% versus 2%, hazard ratio [HR] 3.9, 95% CI 2.9 to 5.3, P <0.0001) and predicted death whether or not left ventricular systolic dysfunction (ejection fraction ≤40%) was present. After adjusting for age, sex, exercise capacity, left ventricular systolic function, presence or absence of myocardial ischemia, and other confounders, an abnormal heart rate recovery remained predictive of death (adjusted HR 2.09, 95% CI 1.49 to 2.82, P <0.001). Conclusions Even in the absence of a cool-down period and even after accounting for left ventricular systolic function, heart rate recovery is a powerful and independent predictor of death.

A strong association exists between degree of SICAD and myocardial scarring seen on CMR.

The study population is part of an ongoing institutional review boardapproved registry of HCM patients at a single tertiary care center (Cleveland Clinic, Ohio), with the initial visit between January 1997Background-We report the predictors of long-term outcomes of symptomatic hypertrophic cardiomyopathy patients undergoing surgical relief of left ventricular outflow tract obstruction. Methods and Results-We studied 699 consecutive patients who have hypertrophic cardiomyopathy with severe symptomatic left ventricular outflow tract obstruction (47±11 years, 63% male) intractable to maximal medical therapy, who were referred to a tertiary hospital between January 1997 and December 2007 for the surgical relief of left ventricular outflow tract obstruction. We excluded patients <18 years of age, those with an ejection fraction <50%, those with hypertensive heart disease of the elderly, and those with more than mild aortic or mitral stenosis. Clinical, echocardiographic, and Holter data were recorded. A composite end point of death, appropriate internal cardioverter defibrillator discharges, resuscitated from sudden death, documented stroke, and admission for congestive heart failure was recorded. During a mean follow-up of 6.2±3 years, 86 patients (12%) met the composite end point with 30-day, 1-year, and 2-year event rates of 0.7%, 2.8%, and 4.7%, respectively. The hard event rate (death, defibrillator discharge, and resuscitated from sudden death) at 30 days, 1 year, and 2 years was 0%, 1.5%, and 3%, respectively. Stepwise multivariable analysis identified residual postoperative atrial fibrillation (hazard ratio, 2.12; confidence interval, 1. The degree of left ventricular (LV) hypertrophy in the study population was deemed significantly out of proportion to the duration and degree of hypertension; this decided after a thorough clinical evaluation by experienced physicians. We excluded the following patients:(1) patients <18 years and >65 years of age, (2) those with hypertensive heart disease of the elderly and concomitant LVOT obstruction, 13-16 (3) those with an ejection fraction <50%, and (4) those with the presence of more than mild aortic or mitral stenosis on the initial echocardiogram. Patients with hypertensive heart disease and concomitant LVOT obstruction were defined as those >65 years of age with a long-standing history of hypertension and characteristic sigmoid-shaped basal septal hypertrophy identified on echocardiography. These patients were excluded because they have a different pathophysiological and genetic profile from the typical HCM patients.13-16 Additionally, we eliminated the potentially confounding effects of end-stage disease (manifesting as depressed LV function) on outcomes by excluding such patients. Clinical DataDemographic, clinical (including standard and HCM-related risk factors, detailed family history, and examination), medication use (including antiarrhythmics and anticoagulation), and electrocardiographic data obtained at the time of the initial and follow-up visits were recor...

Aspirin use among patients undergoing stress echocardiography was independently associated with reduced long-term all-cause mortality, particularly among older patients, those with known coronary artery disease, and those with impaired exercise capacity.

Patients with HCM with abnormal PM have a higher degree of resting LVOT gradient, which is independent of septal thickness.