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Prognostic Value of Reduced Heart Rate Reserve during Exercise in Hypertrophic Cardiomyopathy

Quirino Ciampi1,2, Iacopo Olivotto3, Jesus Peteiro4

  • 1Division of Cardiology, Fatebenefratelli Hospital, 82100 Benevento, Italy.

Journal of Clinical Medicine
|April 3, 2021
PubMed

Insights

A blunted heart rate reserve (HRR) during exercise stress echocardiography independently predicts mortality in hypertrophic cardiomyopathy (HCM) patients. This finding aids in assessing long-term survival for individuals with HCM.

Area of Science:

  • Cardiology
  • Exercise Physiology
  • Medical Diagnostics

Background:

  • Sympathetic nervous system dysfunction can be assessed using heart rate reserve (HRR) during exercise testing.
  • Hypertrophic cardiomyopathy (HCM) is a condition that can affect heart function and patient outcomes.

Purpose of the Study:

  • To evaluate the predictive value of HRR in determining the prognosis of patients diagnosed with HCM.
  • To investigate the relationship between HRR and mortality risk in HCM patients.

Main Methods:

  • 917 HCM patients underwent exercise stress echocardiography (ESE) using various modalities (semi-supine bicycle, upright bicycle, treadmill).
  • Key assessments during ESE included left ventricular outflow tract obstruction (LVOTO), stress-induced regional wall motion abnormalities (RWMA), and HRR.
  • All-cause mortality was tracked during a median follow-up of 89 months.

Main Results:

  • A blunted HRR (lowest quartile ≤ 1.61) was observed in the patient cohort.
  • Multivariable analysis revealed that the lowest quartile of HRR independently predicted death (Hazard ratio 2.354, p = 0.025).
  • Other independent predictors of mortality included RWMA, age, and maximal wall thickness.

Conclusions:

  • A reduced HRR during ESE is a significant independent predictor of survival in patients with HCM.
  • HRR provides valuable prognostic information for HCM patients, separate from the presence of RWMA.
Abstract

Keywords:
autonomic dysfunctionhypertrophic cardiomyopathystress echocardiography

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