Eric D Smith1, June Tome2, Ryan Mcgrath1, Suwen Kumar3, Maryann Concannon1, Sharlene M Day4, Sara Saberi5, Adam S Helms6. 1. Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States of America. 2. School of Medicine, University of Michigan, Ann Arbor, MI, United States of America. 3. Cardiovascular Disease, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, United States of America. 4. Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States of America; Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, United States of America. 5. Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States of America; School of Medicine, University of Michigan, Ann Arbor, MI, United States of America. 6. Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States of America. Electronic address: adamhelm@med.umich.edu.
Abstract
OBJECTIVE: To determine whether abnormal blood pressure response (ABPR), with or without left ventricular outflow tract obstruction (LVOTO), is associated with adverse heart failure and arrhythmia outcomes in hypertrophic cardiomyopathy (HCM). METHODS: A retrospective, single-center analysis was performed for adult HCM patients who underwent exercise stress testing. RESULTS: Of 589 patients included in the study, 192 (33%) demonstrated ABPR. A similar proportion of patients with ABPR had LVOTO compared to those without ABPR (56% vs 63%, p = 0.11). Patients with ABPR demonstrated lower percent predicted VO2 and METs achieved than those with LVOTO (16.9 ± 6.8 vs 21.6 ± 7.9, p = 0.002 and 5.3 ± 2.4 vs 7.4 ± 3.1, p < 0.001). In a subgroup of 17 patients with LVOTO and ABPR who subsequently underwent successful myectomy, 5 (30%) demonstrated persistent ABPR. 23 patients (3.8%) experienced sudden cardiac death or ventricular arrhythmias, which were not associated with ABPR, regardless of age group. In multivariable analysis, syncope (p = 0.04), left ventricular hypertrophy (p = 0.02) and left atrial diameter (p = 0.006) were significantly associated with the composite outcome of sudden death or severe ventricular arrhythmia, whereas ABPR was not (p = 0.38). In contrast, ABPR was associated with subsequent heart failure hospitalization (p = 0.002), regardless of presence or absence of LVOTO (p = 0.04, p = 0.02). CONCLUSIONS: ABPR is associated with reduced functional capacity in HCM regardless of the presence of LVOTO but is not associated with adverse arrhythmia outcomes. Patients with ABPR have a higher incidence of subsequent heart failure hospitalization.
OBJECTIVE: To determine whether abnormal blood pressure response (ABPR), with or without left ventricular outflow tract obstruction (LVOTO), is associated with adverse heart failure and arrhythmia outcomes in hypertrophic cardiomyopathy (HCM). METHODS: A retrospective, single-center analysis was performed for adult HCM patients who underwent exercise stress testing. RESULTS: Of 589 patients included in the study, 192 (33%) demonstrated ABPR. A similar proportion of patients with ABPR had LVOTO compared to those without ABPR (56% vs 63%, p = 0.11). Patients with ABPR demonstrated lower percent predicted VO2 and METs achieved than those with LVOTO (16.9 ± 6.8 vs 21.6 ± 7.9, p = 0.002 and 5.3 ± 2.4 vs 7.4 ± 3.1, p < 0.001). In a subgroup of 17 patients with LVOTO and ABPR who subsequently underwent successful myectomy, 5 (30%) demonstrated persistent ABPR. 23 patients (3.8%) experienced sudden cardiac death or ventricular arrhythmias, which were not associated with ABPR, regardless of age group. In multivariable analysis, syncope (p = 0.04), left ventricular hypertrophy (p = 0.02) and left atrial diameter (p = 0.006) were significantly associated with the composite outcome of sudden death or severe ventricular arrhythmia, whereas ABPR was not (p = 0.38). In contrast, ABPR was associated with subsequent heart failure hospitalization (p = 0.002), regardless of presence or absence of LVOTO (p = 0.04, p = 0.02). CONCLUSIONS: ABPR is associated with reduced functional capacity in HCM regardless of the presence of LVOTO but is not associated with adverse arrhythmia outcomes. Patients with ABPR have a higher incidence of subsequent heart failure hospitalization.
Authors: Quirino Ciampi; Iacopo Olivotto; Jesus Peteiro; Maria Grazia D'Alfonso; Fabio Mori; Luigi Tassetti; Alessandra Milazzo; Lorenzo Monserrat; Xusto Fernandez; Attila Pálinkás; Eszter Dalma Pálinkás; Róbert Sepp; Federica Re; Lauro Cortigiani; Milorad Tesic; Ana Djordjevic-Dikic; Branko Beleslin; Mariangela Losi; Grazia Canciello; Sandro Betocchi; Luis Rocha Lopes; Ines Cruz; Carlos Cotrim; Marco A R Torres; Clarissa C A Bellagamba; Caroline M Van De Heyning; Albert Varga; Gergely Ágoston; Bruno Villari; Valentina Lorenzoni; Clara Carpeggiani; Eugenio Picano Journal: J Clin Med Date: 2021-03-24 Impact factor: 4.241