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[The evolution of the arterial pressure during a stress test in patients with hypertrophic myocardiopathy]
Insights
Patients with hypertrophic cardiomyopathy (HC) often show abnormal exercise blood pressure responses. This abnormal response is linked to a worse functional class, independent of other common clinical indicators.
Area of Science:
- Cardiology
- Exercise Physiology
Background:
- Hypertrophic cardiomyopathy (HC) is a complex condition affecting the heart muscle.
- Understanding exercise hemodynamics is crucial for risk stratification in HC.
- Previous studies have explored various markers, but the exercise blood pressure response in HC requires further investigation.
Purpose of the Study:
- To investigate the exercise blood pressure response in patients with hypertrophic cardiomyopathy (HC).
- To determine the relationship between abnormal blood pressure response during exercise and sudden cardiac death risk.
- To explore correlations between blood pressure increments and other clinical parameters like arrhythmias and left ventricular outflow tract obstruction.
Main Methods:
- Retrospective study of 51 patients diagnosed with HC.
- Analysis of treadmill stress tests, 24-hour Holter monitoring, and echocardiographic examinations.
- Categorization of blood pressure increments (BPI) during stress testing into four patterns, with a focus on normal versus abnormal responses.
Main Results:
- Four patterns of exercise blood pressure response were identified, with a significant proportion of patients exhibiting abnormal responses.
- No significant association was found between abnormal blood pressure increments and factors such as systolic anterior motion (SAM) of the mitral valve or ventricular arrhythmias.
- Patients with abnormal blood pressure responses were more likely to be in a higher New York Heart Association (NYHA) functional class compared to those with normal responses.
Conclusions:
- A substantial number of hypertrophic cardiomyopathy patients exhibit abnormal exercise blood pressure responses.
- This abnormal response appears unrelated to dynamic left ventricular outflow tract obstruction or ventricular ectopic beats.
- A significant correlation exists between abnormal exercise blood pressure response and poorer functional class in HC patients, suggesting its clinical relevance beyond standard noninvasive tests.
Objectives:
To study the exercise blood pressure response in patients with hypertrophic cardiomyopathy (HC) and its relationship with sudden death.
Design:
Retrospective study.
Population:
We studied 51 patients (P) with HC: 18 women and 33 men. Their average age was 45 +/- 14 years, with a mean follow-up of 55 +/- 37 months.
Methods:
Every patient had been subjected to a treadmill stress-test, a 24-hour Holter monitoring and an echocardiographic examination. Particular emphasis was given to blood pressure increments (BPI) during stress-test, the existence of premature ventricular contractions with a frequency of 10 or more per hour (PVC > or = 10), the occurrence of couplets (C) and/or non-sustained ventricular tachycardia (NSVT) on a 24-hour Holter. Finally, the finding of systolic anterior motion (SAM) of the mitral valve, in the routine echocardiogram, was valued.
Results:
Four patterns of BPI were identified: "1": normal evolution (27 P); "2": plateau type increment (16 P); "3": fall in blood pressure during exercise (6 P); "4": abnormal BPI during recovery (2 P). Two groups were considered: group N-normal BPI, group A-patients with abnormal blood pressure responses. There were no significant differences among therapeutic agents, between the two groups, when the stress-test was performed. SAM was found in 21 P. Only 8 P registered ventricular arrhythmias, half of them with NSVT. No statistical relations were found between BPI and P age, the presence of SAM, PVC > or = 10, C, or NSVT. We found 78% of P in group N in NYHA class I. In contrast, in group A only 46% were in class I (p = 0.04). Only one death, of non cardiac cause, occurred (group A).
Conclusions:
There is a large number of patients with HC and abnormal BPI. This is, seemingly, not influenced either by a dynamic left ventricular gradient or by ventricular ectopic beat occurrence. However, a relation appears to exist between the abnormal response and functional class, not explained by the usual (noninvasive) clinical tests.