Diastolic function in hypertrophic cardiomyopathy: relation to exercise capacity

Department of Medicine, Hammersmith Hospital, R.P.M.S., London, England.

Doppler echocardiography was used to assess diastolic function in 40 patients with hypertrophic cardiomyopathy and to relate it to the patients' symptoms, anaerobic threshold and maximal oxygen consumption during cardiopulmonary exercise testing. The patients had a smaller early (E wave) (p less than 0.01), higher late (A wave) (p less than 0.05) mitral diastolic flow velocity, larger A/E ratio (p less than 0.01), longer isovolumetric relaxation time and E wave duration (p less than 0.001) and slower deceleration rate of the E wave (p less than 0.001) than 40 age- and gender-matched normal subjects. In the patients with hypertrophic cardiomyopathy, maximal oxygen consumption and anaerobic threshold were, respectively, 26.3 +/- 9.2 and 21.1 +/- 6.1 ml/kg per min compared with 47 (range 39 to 68) (p less than 0.01) and 41 (range 27 to 58) ml/kg per min (p less than 0.01) in normal subjects. There was no relation between Doppler indexes and symptoms but symptomatic patients had lower maximal oxygen consumption and anaerobic threshold compared with asymptomatic patients (21.4 +/- 7 vs. 30.7 +/- 10, p less than 0.001 and 18.6 +/- 4.7 vs. 23.1 +/- 5.7, respectively, p less than 0.001). In conclusion, Doppler echocardiography can identify abnormalities of left ventricular filling in patients with hypertrophic cardiomyopathy. However, these indexes measured at rest do not correspond to the patient's professed symptomatic status or exercise capacity measured objectively. Conversely, cardiopulmonary exercise testing reveals a depressed maximal oxygen consumption and anaerobic threshold even in the least symptomatic patients.

This article has been cited by other articles:

				B. Pinamonti, A. Di Lenarda, G. Nucifora, D. Gregori, A. Perkan, and G. Sinagra Incremental prognostic value of restrictive filling pattern in hypertrophic cardiomyopathy: a Doppler echocardiographic study Eur J Echocardiogr, July 1, 2008; 9(4): 466 - 471. [Abstract] [Full Text] [PDF]

				D. J. Weaver Jr., T. R. Kimball, T. Knilans, W. Mays, S. K. Knecht, Y. M. Gerdes, S. Witt, B. J. Glascock, J. Kartal, P. Khoury, et al. Decreased Maximal Aerobic Capacity in Pediatric Chronic Kidney Disease J. Am. Soc. Nephrol., March 1, 2008; 19(3): 624 - 630. [Abstract] [Full Text] [PDF]

				D. S. Jassal, T. G. Neilan, M. A. Fifer, I. F. Palacios, P. A. Lowry, G. J. Vlahakes, M. H. Picard, and D. M. Yoerger Sustained improvement in left ventricular diastolic function after alcohol septal ablation for hypertrophic obstructive cardiomyopathy Eur. Heart J., August 1, 2006; 27(15): 1805 - 1810. [Abstract] [Full Text] [PDF]

				J.-W. Ha, J.-R. Cho, J.-M. Kim, J.-A. Ahn, E.-Y. Choi, S.-M. Kang, S.-J. Rim, and N. Chung Tissue Doppler-Derived Indices Predict Exercise Capacity in Patients With Apical Hypertrophic Cardiomyopathy Chest, November 1, 2005; 128(5): 3428 - 3433. [Abstract] [Full Text] [PDF]

				J C C Moon, N G Fisher, W J McKenna, and D J Pennell Detection of apical hypertrophic cardiomyopathy by cardiovascular magnetic resonance in patients with non-diagnostic echocardiography Heart, June 1, 2004; 90(6): 645 - 649. [Abstract] [Full Text] [PDF]

				C. J. McMahon, S. F. Nagueh, R. H. Pignatelli, S. W. Denfield, W. J. Dreyer, J. F. Price, S. Clunie, L. I. Bezold, A. L. Hays, J. A. Towbin, et al. Characterization of Left Ventricular Diastolic Function by Tissue Doppler Imaging and Clinical Status in Children With Hypertrophic Cardiomyopathy Circulation, April 13, 2004; 109(14): 1756 - 1762. [Abstract] [Full Text] [PDF]

				S. J. Skaluba and S. E. Litwin Mechanisms of Exercise Intolerance: Insights From Tissue Doppler Imaging Circulation, March 2, 2004; 109(8): 972 - 977. [Abstract] [Full Text] [PDF]

				B. J. Maron, V. N. Tholakanahalli, A. G. Zenovich, S. A. Casey, D. Duprez, D. M. Aeppli, and J. N. Cohn Usefulness of B-Type Natriuretic Peptide Assay in the Assessment of Symptomatic State in Hypertrophic Cardiomyopathy Circulation, March 2, 2004; 109(8): 984 - 989. [Abstract] [Full Text] [PDF]

				P. M. Shah Hypertrophic cardiomyopathy and diastolic dysfunction J. Am. Coll. Cardiol., July 16, 2003; 42(2): 286 - 287. [Full Text] [PDF]

				I. A. Paraskevaidis, T. Dodouras, S. Adamopoulos, and D. Th. Kremastinos Left Atrial Functional Reserve in Patients With Nonischemic Dilated Cardiomyopathy: An Echocardiographic Dobutamine Study Chest, October 1, 2002; 122(4): 1340 - 1347. [Abstract] [Full Text] [PDF]

				C. Y. Ho, N. K. Sweitzer, B. McDonough, B. J. Maron, S. A. Casey, J.G. Seidman, C. E. Seidman, and S. D. Solomon Assessment of Diastolic Function With Doppler Tissue Imaging to Predict Genotype in Preclinical Hypertrophic Cardiomyopathy Circulation, June 25, 2002; 105(25): 2992 - 2997. [Abstract] [Full Text] [PDF]

				B. J. Maron Hypertrophic Cardiomyopathy: A Systematic Review JAMA, March 13, 2002; 287(10): 1308 - 1320. [Abstract] [Full Text] [PDF]

				Y Matsumura, P M Elliott, M S Virdee, P Sorajja, Y Doi, and W J McKenna Left ventricular diastolic function assessed using Doppler tissue imaging in patients with hypertrophic cardiomyopathy: relation to symptoms and exercise capacity Heart, March 1, 2002; 87(3): 247 - 251. [Abstract] [Full Text] [PDF]

				K. Okeie, M. Shimizu, H. Yoshio, H. Ino, M. Yamaguchi, T. Matsuyama, T. Yasuda, J. Taki, and H. Mabuchi Left ventricular systolic dysfunction during exercise and dobutamine stress in patients with hypertrophic cardiomyopathy J. Am. Coll. Cardiol., September 1, 2000; 36(3): 856 - 863. [Abstract] [Full Text] [PDF]

				E.G. Torrecilla, M.A. Garcia Fernandez, H. Bueno, M. Moreno, and J.L. Delcan Pulmonary venous flow in hypertrophic cardiomyopathy as assessed by the transoesophageal approach: The additive value of pulmonary venous flow and left atrial size variables in estimating the mitral inflow pattern in hypertrophic cardiomyopathy Eur. Heart J., February 2, 1999; 20(4): 293 - 302. [Abstract] [PDF]

				A. T. Yetman, B. W. McCrindle, C. MacDonald, R. M. Freedom, and R. Gow Myocardial Bridging in Children with Hypertrophic Cardiomyopathy -- A Risk Factor for Sudden Death N. Engl. J. Med., October 22, 1998; 339(17): 1201 - 1209. [Abstract] [Full Text] [PDF]

				M. K. Gol, M. Emir, T. Keles, S. A. Kucuker, C. L. Birincioglu, Y. H. Karagoz, T. Kural, O. Tasdemir, S. Goksel, and K. Bayazit Septal Myectomy in Hypertrophic Obstructive Cardiomyopathy: Late Results With Stress Echocardiography Ann. Thorac. Surg., September 1, 1997; 64(3): 739 - 745. [Abstract] [Full Text]

				P. Spirito, C. E. Seidman, W. J. McKenna, and B. J. Maron The Management of Hypertrophic Cardiomyopathy N. Engl. J. Med., March 13, 1997; 336(11): 775 - 785. [Full Text] [PDF]