Related Experiment Videos
Prognostic value of systemic blood pressure response during exercise in a community-based patient population with
I Olivotto1, B J Maron, A Montereggi
1Cardiologia di S. Luca and Medicina Generale III, Ospedale di Careggi, Florence, Italy.
Insights
Abnormal blood pressure response to exercise (ABPR) in hypertrophic cardiomyopathy (HCM) patients indicates higher mortality risk in those under 50. However, ABPR is not a reliable standalone predictor for clinical management decisions.
Area of Science:
- Cardiology
- Exercise Physiology
Background:
- Abnormal blood pressure response to exercise (ABPR) is a potential indicator of hemodynamic instability and mortality risk in hypertrophic cardiomyopathy (HCM).
- Previous studies focused on highly selected HCM populations.
Purpose of the Study:
- To prospectively assess the prognostic significance of ABPR in a community-based HCM cohort.
- To determine if ABPR predicts adverse outcomes across the HCM disease spectrum.
Main Methods:
- 126 HCM patients underwent maximal symptom-limited cycloergometer exercise testing.
- Patients were followed for an average of 4.7 years.
- ABPR was defined as hypotension or a failed blood pressure increase (<20 mm Hg) during exercise.
Main Results:
- 22% of patients exhibited ABPR (hypotension or failed BP rise).
- ABPR was associated with significantly increased cardiovascular mortality risk in patients aged ≤50 years (OR 4.5, p=0.04).
- Positive predictive accuracy for mortality was low (14%), while negative predictive accuracy was high (95%).
Conclusions:
- ABPR occurs in over 20% of community-based HCM patients and predicts worse prognosis in those under 50.
- The low positive predictive accuracy of ABPR limits its use for modifying clinical management or identifying high-risk patients alone.
- High negative predictive accuracy suggests ABPR is valuable for identifying low-risk HCM patient subsets when other risk factors are absent.
Objectives:
The present study was designed to prospectively evaluate the prognostic relevance of abnormal blood pressure response to exercise (ABPR), defined as hypotension or failed blood pressure increase (<20 mm Hg) with exercise, in a community-based hypertrophic cardiomyopathy (HCM) population representative of the overall disease spectrum.
Background:
Abnormal blood pressure response to exercise has been proposed as a marker for hemodynamic instability and increased risk for disease-related mortality in highly selected patient populations with HCM.
Methods:
The study population comprised 126 patients (aged 42+/-14 years) who underwent maximal symptom-limited cycloergometer exercise testing as part of the standard evaluation at our institution, and who were followed systematically for 4.7+/-3.7 years after testing.
Results:
Of the 126 study patients, 98 (78%) had a normal blood pressure response during exercise, whereas the other 28 (22%) had ABPR, including nine with hypotension and 19 with failed blood pressure rise. During the follow-up period, nine patients (7%) died of HCM-related causes (three suddenly and six heart failure-related), of whom four had ABPR. In those patients aged < or =50 years, survival analysis after exercise testing showed a significantly increased risk for cardiovascular mortality associated with ABPR compared with a normal exercise response (p = 0.04), with an odds ratio of 4.5 (95% confidence interval: 1.1, 20.1). However, ABPR showed low positive predictive accuracy for cardiovascular mortality (i.e., 14%), whereas negative predictive accuracy was high (i.e., 95%).
Conclusions:
A hypotensive blood pressure response during exercise occurred in over 20% of a community-based patient cohort with HCM, and was associated with adverse long-term prognosis in patients <50 years old. However, the positive predictive accuracy of this blood pressure response is too low to justify modifications of clinical management or to allow identification of the high-risk patient based solely on an abnormal test result. By virtue of its high negative predictive accuracy for HCM-related mortality, the blood pressure response to exercise appears to be most valuable (in conjunction with the absence of other well recognized risk factors) as a screening test for the identification of low-risk subsets of patients.