|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
|
|
|
|||||||||
|
|||||||||||
|
J Am Coll Cardiol, 1999; 33:2044-2051 © 1999 by the American College of Cardiology Foundation |
* Cardiologia di S.Luca and Medicina Generale III, Ospedale di Careggi, Florence, Italy
Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
Manuscript received July 23, 1997; revised manuscript received January 22, 1999, accepted February 12, 1999.
Reprint requests and correspondence: Dr. Barry J. Maron, 920 E. 28th Street, Suite 40, Minneapolis, Minnesota 55407
gencvres{at}skypoint.com
OBJECTIVES
The present study was designed to prospectively evaluate the prognostic relevance of abnormal blood pressure response to exercise (ABPR), defined as hypotension or failed blood pressure increase (<20 mm Hg) with exercise, in a community-based hypertrophic cardiomyopathy (HCM) population representative of the overall disease spectrum.
BACKGROUND
Abnormal blood pressure response to exercise has been proposed as a marker for hemodynamic instability and increased risk for disease-related mortality in highly selected patient populations with HCM.
METHODS
The study population comprised 126 patients (aged 42 ± 14 years) who underwent maximal symptom-limited cycloergometer exercise testing as part of the standard evaluation at our institution, and who were followed systematically for 4.7 ± 3.7 years after testing.
RESULTS
Of the 126 study patients, 98 (78%) had a normal blood pressure response during exercise, whereas the other 28 (22%) had ABPR, including nine with hypotension and 19 with failed blood pressure rise. During the follow-up period, nine patients (7%) died of HCM-related causes (three suddenly and six heart failure–related), of whom four had ABPR. In those patients aged 
50 years, survival analysis after exercise testing showed a significantly increased risk for cardiovascular mortality associated with ABPR compared with a normal exercise response (p = 0.04), with an odds ratio of 4.5 (95% confidence interval: 1.1, 20.1). However, ABPR showed low positive predictive accuracy for cardiovascular mortality (i.e., 14%), whereas negative predictive accuracy was high (i.e., 95%).
CONCLUSIONS
A hypotensive blood pressure response during exercise occurred in over 20% of a community-based patient cohort with HCM, and was associated with adverse long-term prognosis in patients <50 years old. However, the positive predictive accuracy of this blood pressure response is too low to justify modifications of clinical management or to allow identification of the high-risk patient based solely on an abnormal test result. By virtue of its high negative predictive accuracy for HCM-related mortality, the blood pressure response to exercise appears to be most valuable (in conjunction with the absence of other well recognized risk factors) as a screening test for the identification of low-risk subsets of patients.
| ||||||||
This article has been cited by other articles:
|
|
 |
|
  K Sakata, H Ino, N Fujino, M Nagata, K Uchiyama, K Hayashi, T Konno, M Inoue, H Kato, Y Sakamoto, et al. Exercise-induced systolic dysfunction in patients with non-obstructive hypertrophic cardiomyopathy and mutations in the cardiac troponin genes Heart, October 1, 2008; 94(10): 1282 - 1287. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P Elliott and P Spirito Prevention of hypertrophic cardiomyopathy-related deaths: theory and practice Heart, October 1, 2008; 94(10): 1269 - 1275. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K Prasad, L Williams, R Campbell, P M Elliott, W J McKenna, and M Frenneaux Episodic syncope in hypertrophic cardiomyopathy: evidence for inappropriate vasodilation Heart, October 1, 2008; 94(10): 1312 - 1317. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Sen-Chowdhry and W. J. McKenna Non-invasive risk stratification in hypertrophic cardiomyopathy: don't throw out the baby with the bathwater Eur. Heart J., July 1, 2008; 29(13): 1600 - 1602. [Full Text] [PDF]
|
|
|
|
 |
|
 L. Williams and M. Frenneaux Syncope in hypertrophic cardiomyopathy: mechanisms and consequences for treatment Europace, September 1, 2007; 9(9): 817 - 822. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Thaman, P. M. Elliott, J. S. Shah, B. Mist, L. Williams, R. T. Murphy, W. J. McKenna, and M. P. Frenneaux Reversal of Inappropriate Peripheral Vascular Responses in Hypertrophic Cardiomyopathy J. Am. Coll. Cardiol., September 6, 2005; 46(5): 883 - 892. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. P Frenneaux Assessing the risk of sudden cardiac death in a patient with hypertrophic cardiomyopathy Heart, May 1, 2004; 90(5): 570 - 575. [Full Text] [PDF]
|
|
|
|
 |
|
 K. Toiyama, I. Shiraishi, T. Oka, A. Kawakita, N. Iwasaki, T. Tanaka, K. Sakata, T. Itoi, K. Shuntoh, M. Yamagishi, et al. Assessment of coronary flow reserve with a Doppler guide wire in children with tetralogy of Fallot before and after surgical operation J. Thorac. Cardiovasc. Surg., April 1, 2004; 127(4): 1195 - 1197. [Full Text] [PDF]
|
|
|
|
|
|
B. J. Maron, W. J. McKenna, G. K. Danielson, L. J. Kappenberger, H. J. Kuhn, C. E. Seidman, P. M. Shah, W. H. Spencer III, P. Spirito, F. J. Ten Cate, et al. American College of Cardiology/European Society of Cardiology Clinical Expert Consensus Document on Hypertrophic Cardiomyopathy: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines J. Am. Coll. Cardiol., November 5, 2003; 42(9): 1687 - 1713. [Full Text] [PDF]
|
|
|
|
|
|
Writing Committee Members, B. J. Maron, W. J. McKenna, G. K. Danielson, L. J. Kappenberger, H. J. Kuhn, C. E. Seidman, P. M. Shah, W. H. Spencer III, P. Spirito, et al. American College of Cardiology/European Society of Cardiology Clinical Expert Consensus Document on Hypertrophic Cardiomyopathy: A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines Eur. Heart J., November 1, 2003; 24(21): 1965 - 1991. [Full Text] [PDF]
|
|
|
|
|
|
I. Olivotto, R. Gistri, P. Petrone, E. Pedemonte, D. Vargiu, and F. Cecchi Maximum left ventricular thickness and risk of sudden death in patients with hypertrophic cardiomyopathy J. Am. Coll. Cardiol., January 15, 2003; 41(2): 315 - 321. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Q. Ciampi, S. Betocchi, R. Lombardi, F. Manganelli, G. Storto, M. A. Losi, E. Pezzella, F. Finizio, A. Cuocolo, and M. Chiariello Hemodynamic determinants of exercise-induced abnormal blood pressure response in hypertrophic cardiomyopathy J. Am. Coll. Cardiol., July 17, 2002; 40(2): 278 - 284. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. J. Maron Hypertrophic Cardiomyopathy: A Systematic Review JAMA, March 13, 2002; 287(10): 1308 - 1320. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Kuhn, F. Gietzen, and C. Leuner 'The abrupt no-flow': a no-reflow like phenomenon in hypertrophic cardiomyopathy Eur. Heart J., January 1, 2002; 23(1): 91 - 93. [Full Text] [PDF]
|
|
|
|
|
|
S.G. Priori, E. Aliot, C. Blomstrom-Lundqvist, L. Bossaert, G. Breithardt, P. Brugada, A.J. Camm, R. Cappato, S.M. Cobbe, C. Di Mario, et al. Task Force on Sudden Cardiac Death of the European Society of Cardiology Eur. Heart J., August 2, 2001; 22(16): 1374 - 1450. [PDF]
|
|
|
|
|
|
B.J. Maron Hypertrophic cardiomyopathy and sudden death: new perspectives on risk stratification and prevention with the implantable cardioverter-defibrillator Eur. Heart J., December 2, 2000; 21(24): 1979 - 1983. [PDF]
|
|
|
|
|
|
P. M. Elliott, J. Poloniecki, S. Dickie, S. Sharma, L. Monserrat, A. Varnava, N. G. Mahon, and W. J. McKenna Sudden death in hypertrophic cardiomyopathy: identification of high risk patients J. Am. Coll. Cardiol., December 1, 2000; 36(7): 2212 - 2218. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R.C. Saumarez and A.A. Grace Paced ventricular electrogram fractionation and sudden death in hypertrophic cardiomyopathy and other non-coronary heart diseases Cardiovasc Res, July 1, 2000; 47(1): 11 - 22. [Full Text] [PDF]
|
|
|
|
 |
|
 B. J. Maron, W.-K. Shen, M. S. Link, A. E. Epstein, A. K. Almquist, J. P. Daubert, G. H. Bardy, S. Favale, R. F. Rea, G. Boriani, et al. Efficacy of Implantable Cardioverter-Defibrillators for the Prevention of Sudden Death in Patients with Hypertrophic Cardiomyopathy N. Engl. J. Med., February 10, 2000; 342(6): 365 - 373. [Abstract] [Full Text] [PDF]
|
|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
