Damiano Magri1, Piergiuseppe Agostoni2, Gianfranco Sinagra3, Federica Re4, Michele Correale5, Giuseppe Limongelli6, Elisabetta Zachara4, Vittoria Mastromarino7, Caterina Santolamazza7, Matteo Casenghi7, Giuseppe Pacileo6, Fabio Valente6, Marco Morosin3, Beatrice Musumeci7, Erika Pagannone7, Antonello Maruotti8, Massimo Uguccioni4, Massimo Volpe9, Camillo Autore7. 1. Dpt Clinical and Molecular Medicine, Sapienza University, Rome, Italy. Electronic address: damiano.magri@uniroma1.it. 2. Centro Cardiologico Monzino, IRCCS, Milano, Italy; Dpt of Clinical Sciences and Community Health, University of Milan, Milan, Italy. 3. Cardiovascular Dpt "Ospedali Riuniti" Trieste and Postgraduate School Cardiovascular Sciences, University of Trieste Cardiology Division, Italy. 4. Cardiac Arrhythmia Center and Cardiomyopathies Unit, San Camillo-Forlanini Hospital, Roma, Italy. 5. Dpt of Cardiology, University of Foggia, Foggia, Italy. 6. Cardiologia SUN, Monaldi Hospital, II University of Naples, Naples, Italy. 7. Dpt Clinical and Molecular Medicine, Sapienza University, Rome, Italy. 8. Dpt of Scienze economiche, politiche e delle lingue moderne - Libera Università SS Maria Assunta, Rome, Italy; Centre for innovation and leadership in health sciences, University of Southampton, Southampton, UK. 9. Dpt Clinical and Molecular Medicine, Sapienza University, Rome, Italy; IRCCS - Neuromed, Pozzilli, IS, Italy.
Abstract
BACKGROUND: A blunted heart rate (HR) response is associated with an impaired peak oxygen uptake (pVO2), a powerful outcome predictor in hypertrophic cardiomyopathy (HCM). The present multicenter study sought to determine the prognostic role for exercise-induced HR response in HCM. METHODS: A total of 681 consecutive HCM outpatients on optimized treatment were recruited. The heart failure (HF) end-point was death due to HF, cardiac transplantation, NYHA III-IV class progression, HF worsening leading to hospitalization and severe functional deterioration leading to septal reduction. The sudden cardiac death (SCD) end-point included SCD, aborted SCD and appropriate implantable cardioverter defibrillator discharges. RESULTS: During a median follow-up of 4.2 years (25-75th centile: 3.9-5.2), 81 patients reached the HF and 23 the SCD end-point. Covariates with independent effects on the HF end-point were left atrial diameter, left ventricular ejection fraction, maximal left ventricular outflow tract gradient and exercise cardiac power (ECP = pVO2∗systolic blood pressure) (C-Index = 0.807) whereas the HCM Risk-SCD score and the ECP remained associated with the SCD end-point (C-Index = 0.674). When the VO2-derived variables were not pursued, peak HR (pHR) re-entered in the multivariate HF model (C-Index = 0.777) and, marginally, in the SCD model (C-index = 0.656). A pHR = 70% of the maximum predicted resulted as the best cut-off value in predicting the HF-related events. CONCLUSIONS: The cardiopulmonary exercise test is pivotal in the HCM management, however the pHR remains a meaningful alternative parameter. A pHR < 70% identified a HCM population at high risk of HF-related events, thus calling for a reappraisal of the chronotropic incompetence threshold in HCM.
BACKGROUND: A blunted heart rate (HR) response is associated with an impaired peak oxygen uptake (pVO2), a powerful outcome predictor in hypertrophic cardiomyopathy (HCM). The present multicenter study sought to determine the prognostic role for exercise-induced HR response in HCM. METHODS: A total of 681 consecutive HCM outpatients on optimized treatment were recruited. The heart failure (HF) end-point was death due to HF, cardiac transplantation, NYHA III-IV class progression, HF worsening leading to hospitalization and severe functional deterioration leading to septal reduction. The sudden cardiac death (SCD) end-point included SCD, aborted SCD and appropriate implantable cardioverter defibrillator discharges. RESULTS: During a median follow-up of 4.2 years (25-75th centile: 3.9-5.2), 81 patients reached the HF and 23 the SCD end-point. Covariates with independent effects on the HF end-point were left atrial diameter, left ventricular ejection fraction, maximal left ventricular outflow tract gradient and exercise cardiac power (ECP = pVO2∗systolic blood pressure) (C-Index = 0.807) whereas the HCM Risk-SCD score and the ECP remained associated with the SCD end-point (C-Index = 0.674). When the VO2-derived variables were not pursued, peak HR (pHR) re-entered in the multivariate HF model (C-Index = 0.777) and, marginally, in the SCD model (C-index = 0.656). A pHR = 70% of the maximum predicted resulted as the best cut-off value in predicting the HF-related events. CONCLUSIONS: The cardiopulmonary exercise test is pivotal in the HCM management, however the pHR remains a meaningful alternative parameter. A pHR < 70% identified a HCM population at high risk of HF-related events, thus calling for a reappraisal of the chronotropic incompetence threshold in HCM.
Authors: Sonia Franciosi; Thomas M Roston; Frances K G Perry; Bjorn C Knollmann; Prince J Kannankeril; Shubhayan Sanatani Journal: J Cardiovasc Electrophysiol Date: 2019-07-11
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