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Mechanisms of exercise intolerance in patients with hypertrophic cardiomyopathy
Vy-Van Le1, Marco V Perez, Matthew T Wheeler
1Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA. vyvanle@gmail.com
Insights
In hypertrophic cardiomyopathy (HCM), specific echocardiogram measures like lateral E
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Exercise Physiology
Background:
- Hypertrophic cardiomyopathy (HCM) is a complex genetic heart disease.
- Assessing functional capacity is crucial for managing HCM patients.
- Echocardiography is a key imaging modality in HCM assessment.
Purpose of the Study:
- To investigate the relationship between echocardiographic parameters and exercise capacity in patients with HCM.
- To identify echocardiographic predictors of functional limitation in HCM.
Main Methods:
- Sixty-three patients with HCM underwent cardiopulmonary testing and exercise echocardiography.
- Patients were categorized by HCM morphology (proximal, reverse curvature, apical, concentric).
- Correlations between peak oxygen consumption (Vo2) and echocardiographic findings (wall thickness, gradient, atrial volume, diastolic function indices) were analyzed.
Main Results:
- No significant correlation was found between peak Vo2, left ventricular wall thickness, or intraventricular gradient.
- Peak Vo2 showed significant negative correlation with indexed left atrial volume and lateral E/E' ratio.
- Peak Vo2 demonstrated a significant positive correlation with lateral E' wave velocity.
- A multivariate model including age, lateral E', indexed LA volume, and mitral A wave explained 46% of the variance in peak Vo2.
Conclusions:
- Echocardiographic measures of diastolic function (lateral E') and left atrial size are key determinants of exercise capacity in HCM.
- While concentric HCM morphology was associated with lower peak Vo2, traditional measures like wall thickness and gradient were not predictive of functional capacity.
Aim:
To determine the relation between echocardiogram findings and exercise capacity in hypertrophic cardiomyopathy (HCM).
Methods And Results:
Sixty-three patients (48 +/- 15 years) were referred for cardiopulmonary testing and exercise echocardiography. They were classified by morphology: proximal (n = 11), reverse curvature (n = 32), apical (n = 7), and concentric HCM (n = 13). There were more women in proximal and reverse curvature groups. Proximal HCM patients were older. Maximal left ventricular thickness was highest in reverse curvature group. At peak exercise, concentric HCM achieved the lowest percent predicted maximal Vo2. Excluding apical group, no significant differences in gradient were noted between groups. Overall, no statistically significant correlation was found between peak Vo2, wall thickness, and gradient. Significant correlations were noted between peak Vo2 and indexed left atrial (LA) volume (r = -0.52), lateral E' (r = 0.50), and lateral E/E' ratio (r = -0.46). A multivariate model including age, lateral E', indexed LA volume, and mitral A wave explained 46% of the variance in peak Vo2 (P = .01).
Conclusion:
Lateral E' and indexed LA volume are negatively correlated with functional capacity. Although patients with concentric morphology achieved the lowest peak Vo2, wall thickness and gradient did not predict exercise capacity.
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