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Paradoxical response to exercise in asymptomatic hypertrophic cardiomyopathy: a new description of outflow tract

Stéphane Lafitte1, Patricia Reant, Cecile Touche

  • 1University of Bordeaux, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.

Journal of the American College of Cardiology
|July 2, 2013
PubMed

Insights

Some hypertrophic cardiomyopathy (HCM) patients show a paradoxical response to exercise (PRE), with decreased intraventricular gradients during exertion. This PRE subgroup may have better functional capacity and fewer cardiac events.

Area of Science:

  • Cardiology
  • Echocardiography
  • Cardiovascular Physiology

Background:

  • Hypertrophic cardiomyopathy (HCM) can present with left ventricular outflow tract obstruction.
  • Paradoxical findings include resting obstruction with good exercise tolerance in some HCM patients.

Purpose of the Study:

  • To analyze left ventricular obstruction during exercise echocardiography in hypertrophic cardiomyopathy (HCM) patients.
  • To investigate the phenomenon of paradoxical response to exercise (PRE) in HCM.

Main Methods:

  • Exercise echocardiography was performed on 107 HCM patients.
  • Patients were categorized based on the presence and change in intraventricular gradients at rest and during exercise.

Main Results:

  • Nine patients (PRE) showed a significant decrease in intraventricular gradient during exercise.
  • PRE patients had lower NYHA class, higher LV volumes, and arterial pressure compared to others.
  • PRE patients showed a trend towards reduced cardiac events.

Conclusions:

  • A subgroup of HCM patients, termed PRE, exhibit decreased intraventricular gradients during exercise.
  • Reduced exertional obstruction in PRE patients may correlate with improved functional class and fewer clinical events.
Abstract

Keywords:
HCMLVLVOTLVOTONOBNYHANew York Heart AssociationOBOBIPRESAMexercise echocardiographyhypertrophic cardiomyopathyleft ventricularleft ventricular obstructionleft ventricular outflow tractleft ventricular outflow tract obstructionnonobstructive hypertrophic cardiomyopathy at restobstructive hypertrophic cardiomyopathy at restobstructive hypertrophic cardiomyopathy at rest with increased gradient or no change during exerciseparadoxical response to exercisesystolic anterior motion

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