Comparison of resting and exercise echocardiographic parameters as indicators of outcomes in hypertrophic
Patricia Reant1, Amelie Reynaud1, Xavier Pillois1
1Cardiologic Hospital CHU Bordeaux - CIC0005, Bordeaux University, Pessac, France.
Insights
Resting global longitudinal strain (GLS) and peak exercise left ventricular outflow tract (LVOT) gradient are key indicators for adverse events in hypertrophic cardiomyopathy (HCM) patients. These echocardiographic measures help identify high-risk individuals for improved clinical management.
Area of Science:
- Cardiology
- Echocardiography
- Cardiovascular Imaging
Background:
- Resting and exercise echocardiography provide outcome-predictive variables in hypertrophic cardiomyopathy (HCM).
- Comparing the prognostic value of resting versus exercise echocardiographic parameters in HCM is crucial.
Purpose of the Study:
- To compare the predictive value of resting and exercise echocardiographic parameters for clinical outcomes in HCM patients.
- To identify specific echocardiographic markers that indicate increased risk for adverse events.
Main Methods:
- Prospective echocardiographic evaluation (resting and exercise) in HCM patients.
- Follow-up every 6 months to define a composite cardiac event endpoint.
- Statistical analysis including Cox regression and Kaplan-Meier survival analysis.
Main Results:
- Lower resting global longitudinal strain (GLS) and higher resting left ventricular outflow tract (LVOT) gradient were observed in patients with cardiac events.
- Patients with events had lower peak exercise ejection fractions and greater LVOT gradients.
- Resting GLS ≤ 15% and peak exercise LVOT gradient ≥ 50 mm Hg independently predicted poor outcomes.
Conclusions:
- Resting GLS and peak exercise LVOT gradient are valuable in identifying HCM patients at higher risk for adverse events.
- Exercise echocardiography, particularly LVOT gradient assessment, adds prognostic information.
- These echocardiographic parameters aid in risk stratification for HCM management.
Background:
Both resting echocardiography and exercise echocardiography produce variables predictive of outcomes in patients with hypertrophic cardiomyopathy (HCM). The aim of the present study was to compare the respective value of resting and exercise echocardiographic parameters as indicators of clinical outcomes in patients with HCM.
Methods:
Resting and exercise echocardiography was performed prospectively in patients with HCM evaluated at the HCM Competence Center of Bordeaux and followed up every 6 months. A composite cardiac event was defined.
Results:
One hundred fifteen patients (mean age, 51.9 ± 15.2 years; 66% men) were evaluated by echocardiography and followed for a mean period of 19 ± 11 months. Eighteen patients (16%) reached the composite end point, including 10 progressions to New York Heart Association functional class III or IV. On rest echocardiography, in patients with cardiac events during follow-up, left atrial volume index was significantly more increased, as were lateral E/E' ratio and left ventricular outflow tract (LVOT) gradient, whereas mean global longitudinal strain (GLS) expressed in magnitude (14.0 ± 2.6% vs 17.0 ± 3.6%, P < .001) and peak velocities at the lateral annulus by Doppler tissue imaging were significantly reduced compared with patients without events. At peak exercise, patients who developed cardiac events were characterized by lower ejection fractions and greater LVOT gradients (76 ± 55 mm Hg vs 40 ± 40 mm Hg, P < .002). A Cox backward-entry selection model revealed that GLS ≤ 15% at rest and LVOT gradient ≥ 50 mm Hg at peak exercise were independently associated with an increased risk for poor outcomes in patients with HCM (hazard ratios, 3.8 [P = .017] and 3.3 [P = .028], respectively). On Kaplan-Meier survival analyses, peak exercise LVOT gradient evaluation showed additive value to predict outcomes, particularly in patients with rest GLS > 15% (log-rank P = .001) and despite a resting LVOT gradient ≥ 30 mm Hg (log-rank P = .001).
Conclusion:
This study supports the value of resting GLS and of peak LVOT gradient, measured during exercise echocardiography, in identifying patients with HCM at increased risk for adverse events during follow-up.
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