Prognostic Value of Reduced Heart Rate Reserve during Exercise in Hypertrophic Cardiomyopathy.

Autor: Ciampi Q; Division of Cardiology, Fatebenefratelli Hospital, 82100 Benevento, Italy.; Biomedicine Department, Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy., Olivotto I; Department of Cardiology, Careggi University Hospital, 50134 Florence, Italy., Peteiro J; Department of Cardiology, Complexo Hospitalario Universitario de A Coruña (CHUAC), 15006 A Coruña, Spain., D'Alfonso MG; Department of Cardiology, Careggi University Hospital, 50134 Florence, Italy., Mori F; Department of Cardiology, Careggi University Hospital, 50134 Florence, Italy., Tassetti L; Department of Cardiology, Careggi University Hospital, 50134 Florence, Italy., Milazzo A; Department of Cardiology, Careggi University Hospital, 50134 Florence, Italy., Monserrat L; Department of Cardiology, Complexo Hospitalario Universitario de A Coruña (CHUAC), 15006 A Coruña, Spain., Fernandez X; Department of Cardiology, Complexo Hospitalario Universitario de A Coruña (CHUAC), 15006 A Coruña, Spain., Pálinkás A; Internal Medicine Department, Elisabeth Hospital, 6800 Hódmezővásárhely, Hungary., Pálinkás ED; 2nd Department of Internal Medicine and Cardiology Center, University of Szeged, 6722 Szeged, Hungary., Sepp R; 2nd Department of Internal Medicine and Cardiology Center, University of Szeged, 6722 Szeged, Hungary., Re F; Cardiology Department, San Camillo-Forlanini Hospital, 00118 Roma, Italy., Cortigiani L; Division of Cardiology, San Luca Hospital, 55100 Lucca, Italy., Tesic M; Department of Cardiology, Clinical Center of Serbia, 11000 Belgrade, Serbia., Djordjevic-Dikic A; Department of Cardiology, Clinical Center of Serbia, 11000 Belgrade, Serbia., Beleslin B; Department of Cardiology, Clinical Center of Serbia, 11000 Belgrade, Serbia., Losi M; Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy., Canciello G; Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy., Betocchi S; Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy., Lopes LR; Institute of Cardiovascular Science, University College London, London WC1H 0QB, UK.; Cardiovascular Centre, University of Lisbon, 1649-004 Lisbon, Portugal., Cruz I; Department of Cardiology, Hospital Garcia de Orta, 2810-237 Almada, Portugal., Cotrim C; Heart Center, Hospital da Cruz Vermelha, 1549-008 Lisbon, Portugal.; Medical School, University of Algarve, 8005-139 Faro, Portugal., Torres MAR; Department of Cardiology, Federal University of Rio Grande do Sul, Porto Alegre 90040-060, Brazil., Bellagamba CCA; Department of Cardiology, Federal University of Rio Grande do Sul, Porto Alegre 90040-060, Brazil., Van De Heyning CM; Department of Cardiology, Antwerp University Hospital, 2650 Edegem, Belgium., Varga A; Institute of Family Medicine, University of Szeged, 6720 Szeged, Hungary., Ágoston G; Institute of Family Medicine, University of Szeged, 6720 Szeged, Hungary., Villari B; Division of Cardiology, Fatebenefratelli Hospital, 82100 Benevento, Italy., Lorenzoni V; Institute of Management, Scuola Superiore Sant'Anna, 56127 Pisa, Italy., Carpeggiani C; Biomedicine Department, Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy., Picano E; Biomedicine Department, Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy., The Stress Echo Study Group On Behalf Of The Italian Society Of Echocardiography And Cardiovascular Imaging Siecvi
Jazyk: angličtina
Zdroj: Journal of clinical medicine [J Clin Med] 2021 Mar 24; Vol. 10 (7). Date of Electronic Publication: 2021 Mar 24.
DOI: 10.3390/jcm10071347
Abstrakt: Background: Sympathetic dysfunction can be evaluated by heart rate reserve (HRR) with exercise test.
Objectives: To determine the value of HRR in predicting outcome of patients with hypertrophic cardiomyopathy (HCM).
Methods: We enrolled 917 HCM patients (age = 49 ± 15 years, 516 men) assessed with exercise stress echocardiography (ESE) in 11 centres. ESE modality was semi-supine bicycle in 51 patients (6%), upright bicycle in 476 (52%), and treadmill in 390 (42%). During ESE, we assessed left ventricular outflow tract obstruction (LVOTO), stress-induced new regional wall motion abnormalities (RWMA), and HRR (peak/rest heart rate, HR). By selection, all patients completed the follow-up. Mortality was the predetermined outcome measure Results: During ESE, RWMA occurred in 22 patients (2.4%) and LVOTO (≥50 mmHg) in 281 (30.4%). HRR was 1.90 ± 0.40 (lowest quartile ≤ 1.61, highest quartile > 2.13). Higher resting heart rate (odds ratio 1.027, 95% CI: 1.018-1.036, p < 0.001), older age (odds ratio 1.021, 95% CI: 1.009-1.033, p < 0.001), lower exercise tolerance (mets, odds ratio 0.761, 95% CI: 0.708-0.817, p < 0.001) and resting LVOTO (odds ratio 1.504, 95% CI: 1.043-2.170, p = 0.029) predicted a reduced HRR. During a median follow-up of 89 months (interquartile range: 36-145 months), 90 all-cause deaths occurred. At multivariable analysis, lowest quartile HRR (Hazard ratio 2.354, 95% CI 1.116-4.968 p = 0.025) and RWMA (Hazard ratio 3.279, 95% CI 1.441-7.461 p = 0.004) independently predicted death, in addition to age (Hazard ratio 1.064, 95% CI 1.043-1.085 p < 0.001) and maximal wall thickness (Hazard ratio 1.081, 95% CI 1.037-1.128, p < 0.001).
Conclusions: A blunted HRR during ESE predicts survival independently of RWMA in HCM patients.
Databáze: MEDLINE
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