Prospective Prognostic Assessment of Blood Pressure Response During Exercise in Patients With Hypertrophic Cardiomyopathy

Abstract

A normal exercise blood pressure response identifies low-risk young patients with HCM. An ABPR identifies the high-risk cohort; the low positive predictive accuracy, however, indicates that further risk stratification is warranted.

Estratificação de risco para morte súbita na cardiomiopatia hipertrófica: bases genéticas e clínicas

“…51,52 It is associated with sudden death especially in individuals under fifty years of age. 52 Evidence of this abnormality is present in roughly 30% of the patients.…”

“…43 Among young people it presents a reduced positive predictive value and an elevated negative predictive value. 51,52 It develops by inappropriate vasodilation of the unexercised skeletal muscle vessels and is associated with the stimulation of baroreceptors due to wall stress or ischemia. 51,52 The lack of pathological vasoconstriction or dilation of the capacitance vessels contributes to the generation of blood pressure abnormalities during or immediately following upright physical exercise.…”

“…51,52 It develops by inappropriate vasodilation of the unexercised skeletal muscle vessels and is associated with the stimulation of baroreceptors due to wall stress or ischemia. 51,52 The lack of pathological vasoconstriction or dilation of the capacitance vessels contributes to the generation of blood pressure abnormalities during or immediately following upright physical exercise. The mechanism would be similar to that of vasovagal syncope, which in healthy people does not contribute to the development of sudden death as there is no anomalous electrophysiological substrate.…”

Fibrose miocárdica em pacientes com cardiomiopatia hipertrófica com alto risco para morte súbita cardíaca

“…Despite the traditional clinical criteria of worse prognosis [5][6][7][8][9][10][11][12] and the genetic advances with regard to the discovery of over 200 mutations that are responsible for the disease [13][14][15][16][17][18] , the stratification of sudden death risk in hypertrophic cardiomyopathy (HCM) continues to be a true challenge due to the great heterogeneity of its presentation, as most individuals remain asymptomatic during their entire lives and some others present sudden death as first symptom.…”

Hemodynamic changes and prognosis in patients with hypertrophic cardiomyopathy and abnormal blood pressure responses during exercise

“…[7][8][9] Furthermore, the literature suggests that abnormal BPR is caused by an inappropriate decrease in systemic vascular resistance (SVR), 9,10 and subendocardial ischemia. 11 On the other hand, we previously reported that some patients with nonobstructive HCM showed systolic dysfunction during exercise.…”