Exercise and myocardial injury in hypertrophic cardiomyopathy
| Autor: | G. Etienne Cramer, Marcel J.M. Kofflard, Menko-Jan de Boer, D.H. Frank Gommans, Marc A. Brouwer, Michelle Michels, Michael A. Fouraux, Jeannette Bakker, Hendrik-Jan Dieker, Freek W.A. Verheugt, Janneke Timmermans |
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| Přispěvatelé: | Cardiology |
| Rok vydání: | 2020 |
| Předmět: |
Male
Time Factors Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] 030204 cardiovascular system & hematology Muscle hypertrophy 0302 clinical medicine High oxygen Risk Factors Active disease 030212 general & internal medicine Prospective Studies Netherlands medicine.diagnostic_test biology Hypertrophic cardiomyopathy Middle Aged Prognosis Up-Regulation Cardiology Female Cardiology and Cardiovascular Medicine Adult medicine.medical_specialty Magnetic Resonance Imaging Cine macromolecular substances exercise CMR Risk Assessment 03 medical and health sciences Troponin T Predictive Value of Tests Internal medicine cardiac troponin medicine Late gadolinium enhancement Humans In patient Heart Failure and Cardiomyopathies Aged business.industry Myocardium Magnetic resonance imaging Cardiomyopathy Hypertrophic medicine.disease hypertrophic cardiomyopathy Troponin Bicycling Case-Control Studies biology.protein Exercise Test business Biomarkers |
| Zdroj: | Heart, 106(15), 1169-1175. BMJ Publishing Group Heart, 106, 15, pp. 1169-75 Heart, 106, 1169-75 Heart |
| ISSN: | 1355-6037 |
| DOI: | 10.1136/heartjnl-2019-315818 |
| Popis: | ObjectiveTroponin and high signal intensity on T2-weighted (HighT2) cardiovascular magnetic resonance imaging (CMRi) are both markers of myocardial injury in hypertrophic cardiomyopathy (HCM). The interplay between exercise and disease development remains uncertain in HCM. We sought to assess the occurrence of postexercise troponin rises and its determinants.MethodsMulticentre project on patients with HCM and mutation carriers without hypertrophy (controls). Participants performed a symptom limited bicycle test with hs-cTnT assessment pre-exercise and 6 hours postexercise. Pre-exercise CMRi was performed in patients with HCM to assess measures of hypertrophy and myocardial injury. Depending on baseline troponin (< or >13 ng/L), a rise was defined as a >50% or >20% increase, respectively.ResultsTroponin rises occurred in 18% (23/127) of patients with HCM and 4% (2/53) in mutation carriers (p=0.01). Comparing patients with HCM with and without a postexercise troponin rise, maximum heart rates (157±19 vs 143±23, p=0.004) and maximal wall thickness (20 mm vs 17 mm, p=0.023) were higher in the former, as was the presence of late gadolinium enhancement (85% vs 57%, p=0.02). HighT2 was seen in 65% (13/20) and 19% (15/79), respectively (pConclusionsPostexercise troponin rises were seen in about 20% of patients with HCM, almost five times more frequent than in mutation carriers. HighT2 on CMRi may identify a group of particularly vulnerable patients, supporting the concept that HighT2 reflects an active disease state, prone to additional injury after a short episode of high oxygen demand. |
| Databáze: | OpenAIRE |
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