Exercise Echocardiography in Asymptomatic HCM

Desai, Milind Y.; Bhonsale, Aditya; Patel, Parag; Naji, Peyman; Smedira, Nicholas G.; Thamilarasan, Maran; Lytle, Bruce W.; Lever, Harry M.

doi:10.1016/j.jcmg.2013.08.010

Cited by 117 publications

(46 citation statements)

References 43 publications

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“…A history of diabetes was the second strongest predictor of compromised exercise capacity in HOCM patients. The prevalence of diabetes in the present study (~9%) was in line with previous studies of HCM patients (3–16%) [ 9 , 10 , 11 , 16 , 28 ]. In support of the relationship between diabetes and reduced exercise capacity in HOCM, diabetes is independently associated with cardiac hypertrophy (often termed “diabetic cardiomyopathy”), compromised systolic and diastolic function, and risk of heart failure [ 29 , 30 ].…”

Section: Discussionsupporting

confidence: 93%

“…Furthermore, obstruction is associated with a further reduction in VO 2 peak in HCM [ 9 , 10 , 14 , 15 ]. HCM patients also exhibit numerous cardiovascular risk factors, including diabetes, arterial hypertension, and coronary artery disease [ 9 , 10 , 11 , 16 , 17 ]. However, the contribution of these cardiovascular risk factors to the worsening of VO 2 peak in patients with HOCM is unknown.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Exercise Capacity in Patients with Hypertrophic Obstructive Cardiomyopathy

Smith

Medina‐Inojosa

Layrisse

et al. 2018

JCM

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Hypertrophic obstructive cardiomyopathy (HOCM) patients exhibit compromised peak exercise capacity (VO2peak). Importantly, severely reduced VO2peak is directly related to increased morbidity and mortality in these patients. Therefore, we sought to determine clinical predictors of VO2peak in HOCM patients. HOCM patients who performed symptom-limited cardiopulmonary exercise testing between 1995 and 2016 were included for analysis. Peak VO2 was reported as absolute peak VO2, indexed to body weight and analyzed as quartiles, with quartile 1 representing the lowest VO2peak. Step-wise regression models using demographic features and clinical and physiologic characteristics were created to determine predictors of HOCM patients with the lowest VO2peak. We included 1177 HOCM patients (age: 53 ± 14 years; BMI: 24 ± 12 kg/m2) with a VO2peak of 18.0 ± 5.6 mL/kg/min. Significant univariate predictors of the lowest VO2peak included age, female sex, New York Health Association (NYHA) class, BMI, left atrial volume index, E/e’, E/A, hemoglobin, N-terminal pro b-type natriuretic peptide (NT-proBNP), and a history of diabetes, hypertension, stroke, atrial fibrillation, or coronary artery disease. Independent predictors of the lowest VO2peak included age (OR, CI: 1.03, 1.02–1.06; p < 0.0001), women (4.66, 2.94–7.47; p = 0.001), a history of diabetes (2.05, 1.17–3.60; p = 0.01), BMI (0.94, 0.92–0.96; p < 0.0001), left atrial volume index (1.07, 1.05–1.21; p = 0.04), E/e’ (1.05, 1.01–1.08; p = 0.004), hemoglobin (0.76, 0.65–0.88; p = 0.0004), and NT-proBNP (1.72, 1.42–2.11; p < 0.0001). These findings demonstrate that demographic factors (i.e., age and sex), comorbidities (e.g., diabetes and obesity), echocardiography indices, and biomarkers (e.g., hemoglobin and NT-proBNP) are predictive of severely compromised VO2peak in HOCM patients.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Predictors of Exercise Capacity in Patients with Hypertrophic Obstructive Cardiomyopathy

Smith

Medina‐Inojosa

Layrisse

et al. 2018

JCM

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“…6, 7, 14 Likewise a new study from Desai et al found exercise capacity to be a predictor of SCD in HCM patients. 23 All these parameters are also relevant in high gradient HCM and in our cohort of obstructive HCM the exercise testing provided information useful in risk stratification in a substantial amount of patients.…”

Section: Discussionmentioning

confidence: 85%

Safety profile and utility of treadmill exercise in patients with high-gradient hypertrophic cardiomyopathy

Sorensen

Liang

Pinheiro

et al. 2017

American Heart Journal

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Background Exercise echocardiography in the evaluation of Hypertrophic Cardiomyopathy (HCM) provides valuable information for risk stratification, selection of optimal treatment and prognostication. However, HCM patients with left ventricular outflow (LVOT) gradients ≥30 mmHg are often excluded from exercise testing because of safety considerations. We examined the safety and utility of exercise testing in high-gradient HCM patients. Methods We evaluated clinical characteristics, hemodynamics and imaging variables in 499 consecutive HCM patients who performed 959 exercise tests. Patients were divided on the basis of peak LVOT gradients using a 30 mmHg threshold into: obstructive (n=152), labile-obstructive (n=178) and non-obstructive (n=169) groups. Results There were no deaths during exercise testing. We noted 20 complications (2.1% of tests) including 3 serious ventricular arrhythmias (0.3% of tests). There was no difference in complication rate between groups. Obstructive HCM patients had a higher frequency of abnormal blood pressure response (obstructive: 53% versus labile-obstructive: 41% and non-obstructive: 37%, p=0.008). Obstructive patients also displayed a lower work capacity (obstructive: 8.4±3.4 versus labile-obstructive: 10.9±4.2 and non-obstructive: 10.2±4.0, METs, p<0.001). Exercise testing provided incremental information regarding sudden cardiac death risk in 19% of high gradient HCM patients and we found poor correlation between patient-reported functional class and work capacity. Conclusion Our results suggest that exercise testing in HCM is safe and serious adverse events are rare. Although numbers are limited, exercise testing in high gradient HCM appears to confer no significant additional safety hazard in our selected cohort and could potentially provide valuable information.

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“…25,26 Stress testing can also be useful for risk stratifi cation in asymptomatic patients, with one study showing that those who achieve more than 100% of their age-and sex-predicted metabolic equivalents have a low event rate. 27…”

Section: Stress Testing For Risk Stratifi Cationmentioning

confidence: 99%

Hypertrophic cardiomyopathy: A complex disease

Young

Smedira

Tower‐Rader

et al. 2018

CCJM

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Hypertrophic cardiomyopathy (HCM) is a complex cardiovascular disease with wide phenotypic variations. Despite significant advances in imaging and genetic testing, more information is needed about the roles and implications of these resources in clinical practice. Patients with suspected or established HCM should be evaluated at an expert referral center to allow for the best multidisciplinary care. Research is needed to better predict the risk of sudden cardiac death in those judged to be at low risk by current risk-stratification methods.

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Exercise Echocardiography in Asymptomatic HCM

Abstract: In asymptomatic or minimally symptomatic HCM patients, exercise stress testing provides excellent risk stratification, with a low event rate in patients achieving >100% of predicted METs.

Cited by 117 publications

References 43 publications

Predictors of Exercise Capacity in Patients with Hypertrophic Obstructive Cardiomyopathy

Predictors of Exercise Capacity in Patients with Hypertrophic Obstructive Cardiomyopathy

Safety profile and utility of treadmill exercise in patients with high-gradient hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy: A complex disease

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