CLINICAL STUDY
Left ventricular systolic dysfunction during exercise and dobutamine stress in patients with hypertrophic cardiomyopathy
Kazuyasu Okeie, MDa,
Masami Shimizu, MDa,
Hiroyuki Yoshio, MDa,
Hidekazu Ino, MDa,
Masato Yamaguchi, MDa,
Toru Matsuyama, MDa,
Toshihiko Yasuda, MDa,
Junichi Taki, MD* and
Hiroshi Mabuchi, MDa
a Second Department of Internal Medicine, Kanazawa University, Kanazawa, Japan
* Department of Nuclear Medicine, School of Medicine, Kanazawa University, Kanazawa, Japan
Manuscript received November 25, 1998;
revised manuscript received March 1, 2000,
accepted April 11, 2000.
Reprint requests and correspondence: Kazuyasu Okeie, the Second Department of Internal Medicine, School of Medicine, Kanazawa University, Takara-machi 13-1, Kanazawa 920-8641, Japan yonken1{at}med.kanazawa-u.ac.jp
OBJECTIVES
We sought to characterize stress-induced left ventricular systolic dysfunction in patients with hypertrophic cardiomyopathy (HCM).
BACKGROUND
Myocardial ischemia and diastolic dysfunction occur in patients with HCM. We hypothesized that, in the setting of transient myocardial ischemia, left ventricular systolic dysfunction occurs during exercise and dobutamine stress.
METHODS
We studied 39 patients with HCM but without obstructive symptoms at rest or coronary artery disease. A continuous ventricular function monitor equipped with cadmium telluride detectors (VEST) was used to evaluate left ventricular function during supine bicycle ergometer exercise. Dobutamine stress echocardiography (DSE) was also performed. The left ventricular ejection fraction (LVEF) and regional wall motion were determined from echocardiographic images.
RESULTS
Changes in the LVEF correlated between exercise and dobutamine stress (r = 0.643, p < 0.0001). The LVEF decreased more than 5% at peak exercise in 17 of patients (group II), while the other patients had normal responses (group I). New regional wall motion abnormalities during dobutamine infusion were detected in 18 of 110 (16.4%) segments in group I and 42 of 85 (49.4%) segments in group II. Decreased or unchanged regional wall motion occurred more frequently in hypertrophied segments than in nonhypertrophied segments (p < 0.0001). There were significant inverse correlations between the LVEF responses during both stresses and the number of abnormal segments noted during dobutamine stress in all patients (VEST: p < 0.005; DSE: p < 0.0005). Signs of left ventricular obstruction were observed in 11 of 39 patients during DSE. However, there was no significant correlation between the LVEF response and the dobutamine-induced left ventricular pressure gradient.
CONCLUSIONS
Exercise-induced systolic dysfunction occurred in 50% of patients with HCM. In these patients, regional wall motion abnormalities were present in hypertrophied segments.
|
Abbreviations and Acronyms
| | ANOVA | = analysis of variance | | CAD | = coronary artery disease | | DSE | = dobutamine stress echocardiography | | ECG | = electrocardiography | | EDV | = left ventricular end-diastolic volume | | ESV | = left ventricular end-systolic volume | | HCM | = hypertrophic cardiomyopathy | | LV | = left ventricle or ventricular | | LVEF | = left ventricular ejection fraction | | VEST | = continuous ventricular function monitor equipped with cadmium telluride detectors |
|
This article has been cited by other articles:

|
 |

|
 |
 
M. V. Sherrid, O. Wever-Pinzon, A. Shah, and F. A. Chaudhry
Reflections of inflections in hypertrophic cardiomyopathy.
J. Am. Coll. Cardiol.,
July 14, 2009;
54(3):
212 - 219.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. K. Dhar, V. Varadharajan, A. Al-Mohammad, J. Sandoval, and E. D Grech
Symptomatic hypertrophic obstructive cardiomyopathy: semi-supine bicycle ergometry as a useful provocative manoeuvre to elicit latent gradient
BMJ Case Reports,
March 30, 2009;
2009(mar30_1):
bcr1020081044 - bcr1020081044.
[Abstract]
[Full Text]
|
 |
|

|
 |

|
 |
 
H. Ashrafian and H. Watkins
Exercise-induced ventricular dysfunction in hypertrophic cardiomyopathy: stunning by any other name?
Heart,
October 1, 2008;
94(10):
1251 - 1253.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J S Shah, M T T Esteban, R Thaman, R Sharma, B Mist, A Pantazis, D Ward, S K Kohli, S P Page, C Demetrescu, et al.
Prevalence of exercise-induced left ventricular outflow tract obstruction in symptomatic patients with non-obstructive hypertrophic cardiomyopathy
Heart,
October 1, 2008;
94(10):
1288 - 1294.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J Ingles, A Doolan, C Chiu, J Seidman, C Seidman, and C Semsarian
Compound and double mutations in patients with hypertrophic cardiomyopathy: implications for genetic testing and counselling
J. Med. Genet.,
October 1, 2005;
42(10):
e59 - e59.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
R Thaman, J R Gimeno, R T Murphy, T Kubo, B Sachdev, J Mogensen, P M Elliott, and W J McKenna
Prevalence and clinical significance of systolic impairment in hypertrophic cardiomyopathy
Heart,
July 1, 2005;
91(7):
920 - 925.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
B. J. Maron, J. A. Dearani, S. R. Ommen, M. S. Maron, H. V. Schaff, B. J. Gersh, and R. A. Nishimura
The case for surgery in obstructive hypertrophic cardiomyopathy
J. Am. Coll. Cardiol.,
November 16, 2004;
44(10):
2044 - 2053.
[Abstract]
[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]
|
 |
|

|
 |

|
 |
 
S. Betocchi, Q. Ciampi, and A. Cuocolo
What is the mechanism of abnormal blood pressure response on exercise in hypertrophic cardiomyopathy?: Reply
J. Am. Coll. Cardiol.,
June 4, 2003;
41(11):
2102 - 2104.
[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]
|
 |
|

|
 |

|
 |
 
F. Cecchi, I. Olivotto, R. Roberts, and U. Sigwart
New Concepts in Hypertrophic Cardiomyopathies * Response
Circulation,
June 11, 2002;
105
(23):
e188 - e188.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. Shimizu, H. Ino, M. Yamaguchi, H. Terai, K. Hayashi, K. Nakajima, J. Taki, and H. Mabuchi
Heterogeneity of Cardiac Sympathetic Nerve Activity and Systolic Dysfunction in Patients with Hypertrophic Cardiomyopathy
J. Nucl. Med.,
January 1, 2002;
43(1):
15 - 20.
[Abstract]
[Full Text]
[PDF]
|
 |
|
|