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Tissue Doppler-derived indices predict exercise capacity in patients with apical hypertrophic cardiomyopathy
Jong-Won Ha1, Jung-Rae Cho, Jin-Mi Kim
1Cardiology Division, Yonsei University College of Medicine, Seoul, Korea. jwha@yumc.yonsei.ac.kr
Insights
Diastolic dysfunction in apical hypertrophic cardiomyopathy (ApHCM) impacts exercise capacity. Doppler tissue imaging (DTI) indexes, specifically the E/E' ratio, are strong predictors of maximal oxygen uptake (Vo2max) in ApHCM patients.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Exercise Physiology
Background:
- Impaired left ventricular (LV) diastolic function is characteristic of hypertrophic cardiomyopathy (HCM).
- Diastolic function and its impact on exercise capacity in apical HCM (ApHCM) remain understudied.
- This study investigates the relationship between diastolic function and exercise capacity in ApHCM patients.
Purpose of the Study:
- To determine the correlation between diastolic mitral annular velocities and conventional Doppler indices with exercise capacity in ApHCM.
- To identify echocardiographic predictors of exercise capacity in ApHCM.
Main Methods:
- Twenty-nine ApHCM patients underwent supine bicycle exercise with simultaneous respiratory gas analysis.
- Two-dimensional and Doppler echocardiography, including Doppler tissue imaging (DTI), were performed.
- Mitral inflow velocities, early diastolic mitral annular velocity (E'), and E/E' ratio were measured.
Main Results:
- The E/E' ratio showed an inverse correlation with maximal oxygen uptake (Vo2max) (r = -0.47, p = 0.0106).
- Early diastolic mitral annular velocity (E') positively correlated with Vo2max (r = 0.41, p = 0.024).
- The E/E' ratio was the strongest independent predictor of Vo2max.
Conclusions:
- Doppler tissue imaging (DTI)-derived indexes (E', E/E' ratio) correlate with exercise capacity in ApHCM.
- Abnormal diastolic function, as estimated by DTI, may limit exercise capacity in ApHCM.
- E/E' ratio is a valuable clinical parameter for assessing exercise limitation in ApHCM.
Background:
Although impaired left ventricular (LV) diastolic function is a prominent feature of hypertrophic cardiomyopathy (HCM), diastolic function and its relation to exercise capacity in apical HCM (ApHCM) has not been explored previously. This study was sought to determine the relationship between diastolic mitral annular velocities combined with conventional Doppler indexes and exercise capacity in patients with ApHCM.
Patients:
Twenty-nine patients with ApHCM (24 men; mean age +/- SD, 57 +/- 10 years) underwent supine bicycle exercise with simultaneous respiratory gas analysis and two-dimensional and Doppler echocardiographic study.
Results:
The mitral inflow velocities (early filling [E], late filling, and deceleration time) were traced and measured. Early diastolic mitral annular velocity (E') was measured at the septal corner of mitral annulus by Doppler tissue imaging (DTI) from the apical four-chamber view. Pro-brain natriuretic peptide (proBNP) was measured at the time of echocardiography using a quantitative electrochemiluminescence immunoassay. E/E' ratio correlated inversely with maximal oxygen uptake (Vo(2)max) [r = - 0.47, p = 0.0106]. There was a significant positive correlation between E' and Vo(2)max (r = 0.41, p = 0.024). However, no correlation was found between conventional two-dimensional, Doppler indices, and proBNP and Vo(2)max). Of all the echocardiographic and clinical parameters assessed, E/E' ratio had the best correlation with exercise capacity (r - 0.47) and was the strongest independent predictor of Vo(2)max by multivariate analysis (p = 0.0106).
Conclusions:
DTI-derived indexes (E', E/E' ratio), an estimate of myocardial relaxation and LV filling pressures, correlate with exercise capacity in patients with ApHCM, suggesting that abnormal diastolic function may be a factor limiting exercise capacity.
