Diastolic Stress Echocardiography in Patients With Hypertrophy Cardiomyopathy: Association With Exercise Capacity

IF 4.6 Q2 MATERIALS SCIENCE, BIOMATERIALS
Agostina M. Fava MD, Zoran B. Popovic MD, PhD, Alaa Alashi MD, Maran Thamilarasan MD, Bo Xu MD, Milind Y. Desai MD, MBA
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Abstract

Diastolic dysfunction plays a major role in precipitating congestive heart failure in patients with hypertrophic cardiomyopathy (HCM). In many such patients, symptoms are unmasked only during exercise because left ventricular (LV) filling pressure is normal at rest but increase with exercise. We sought to establish whether abnormal postexercise diastolic parameters are associated with reduced exercise capacity in patients with HCM. We examined 590 patients with asymptomatic/minimally symptomatic HCM (age 54 ± 14 years, 57% men, body mass index 30 ± 6 kg/m2, 84% on β blockers) with HCM by 2-dimensional and Doppler echocardiography at rest and after maximal treadmill exercise echocardiography (TSE). A complete echocardiogram (including LV ejection fraction, LV thickness, LV outflow tract [LVOT] gradient, degree of mitral regurgitation) was recorded. Diastolic parameters (septal and lateral [e’] velocities of the mitral annulus, peak early [E] and late [A] mitral inflow velocity, E/A ratio, E/e’, right ventricular systolic pressure [RVSP], and left atrial volume index) were recorded at rest and after TSE. Exercise functional capacity was recorded and divided into <85% or >85% of age-gender predicted metabolic equivalents (AGP-METs). After maximal exercise, 32% patients had at least moderate mitral regurgitation, mean LVOT gradient was 61 ± 59 mm Hg, E/A ratio was 1.2 ± 1.0, average E/e’ ratio 12.9 ± 1.0, and peak RVSP was 36 ± 15 mm Hg. Only 42% of patients achieved >85% of AGP-METs; the mean METs was 7 ± 3. On multivariable logistic regression analysis, higher body mass index (odds ratio [OR] 1.05), β-blocker use (OR 2.58), higher left atrial volume index (OR 1.02), higher peak stress LVOT gradient (LVOTG) (OR 1.06), peak stress E/e’ (OR 1.04), and higher RVSP (OR 1.03) were independently associated with <85% AGP-METs achieved (all p <0.05). In conclusion, in patients with asymptomatic/minimally symptomatic HCM who underwent TSE, there is a significant and independent association between abnormal diastolic response to exercise and reduced exercise capacity in HCM. Incorporating diastolic parameters during stress echocardiography could provide incremental diagnostic utility in deciphering the exact etiology of dyspnea in such patients.
肥厚型心肌病患者的舒张压超声心动图:与运动能力的关系
舒张功能障碍是肥厚型心肌病(HCM)患者发生充血性心力衰竭(CHF)的主要诱因。许多此类患者的症状只有在运动时才会显现,因为左心室充盈压在静息时正常,但在运动时会升高。我们试图确定运动后舒张参数异常是否与 HCM 患者运动能力下降有关。我们通过二维和多普勒超声心动图检查了 590 名无症状/轻微症状的 HCM 患者(54±14 岁,57% 为男性,体重指数 30±6kg/m2,84% 正在服用倍他受体阻滞剂),这些患者均在静息状态下和最大跑步机运动超声心动图(TSE)检查后接受了检查。记录完整的超声心动图(包括左心室射血分数、左心室厚度、左心室流出道[LVOT]梯度、二尖瓣反流[MR]程度)。记录静息时和 TSE 后的舒张参数(二尖瓣环的室间隔和侧[e']速度、早期[E]和晚期[A]二尖瓣流入峰值速度、E/A 比值、E/e'、右心室收缩压[RVSP]和左心房容积指数[LAVI])。记录运动功能能力,并将其分为 85% 的年龄-性别预测代谢当量(AGP-MET)。最大运动后,32% 的患者至少有中度 MR,平均 LVOT 梯度为 61±59 mmHg,E/A 比值为 1.2±1.0,平均 E/e' 比值为 12.9±1.0,峰值 RVSP 为 36±15 mmHg。经多变量逻辑回归分析,较高的体重指数(几率比 [OR] 1.05)、使用受体阻滞剂(OR 2.58)、较高的 LAVI(OR 1.02)、较高的峰值压力 LVOTG(OR 1.06)、峰值压力 E/e'(OR 1.04)和较高的 RVSP(OR 1.03)与以下因素独立相关
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来源期刊
ACS Applied Bio Materials
ACS Applied Bio Materials Chemistry-Chemistry (all)
CiteScore
9.40
自引率
2.10%
发文量
464
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