Prognostic Value of Exercise Echocardiography in Patients with Hypertrophic Cardiomyopathy

Peteiro, Jesús; Bouzas-Mosquera, Alberto; Fernandez, Xusto; Monserrat, Lorenzo; Pazos, Pablo; Estevez-Loureiro, Rodrigo; Castro-Beiras, Alfonso

doi:10.1016/j.echo.2011.11.005

« Previous Next »Journal of the American Society of Echocardiography
Volume 25, Issue 2 , Pages 182-189, February 2012

Prognostic Value of Exercise Echocardiography in Patients with Hypertrophic Cardiomyopathy

This report was partially presented at the European Society of Cardiology Congress 2010, Stockholm, Sweden.

Jesús Peteiro, MD, PhD
- Laboratory of Stress Echocardiography, Complexo Hospitalario Universitario de A Coruña, University of A Coruña, A Coruña, Spain
- Reprint requests: Jesús Peteiro, P/Ronda 5-4° izda., 15011-A Coruña, Spain.
Alberto Bouzas-Mosquera, MD
- Laboratory of Stress Echocardiography, Complexo Hospitalario Universitario de A Coruña, University of A Coruña, A Coruña, Spain
Xusto Fernandez, MD
- Unit of Cardiomyopathies, Complexo Hospitalario Universitario de A Coruña, University of A Coruña, A Coruña, Spain
Lorenzo Monserrat, MD, PhD
- Unit of Cardiomyopathies, Complexo Hospitalario Universitario de A Coruña, University of A Coruña, A Coruña, Spain
Pablo Pazos, MD
- Laboratory of Stress Echocardiography, Complexo Hospitalario Universitario de A Coruña, University of A Coruña, A Coruña, Spain
Rodrigo Estevez-Loureiro, MD
- Laboratory of Stress Echocardiography, Complexo Hospitalario Universitario de A Coruña, University of A Coruña, A Coruña, Spain
Alfonso Castro-Beiras, MD, PhD
- Department of Cardiology, Complexo Hospitalario Universitario de A Coruña, University of A Coruña, A Coruña, Spain

published online 05 December 2011.

Background

Although exercise echocardiography may assess left ventricular (LV) function and LV outflow tract (LVOT) gradients during exercise in patients with hypertrophic cardiomyopathy (HCM), its value for predicting outcomes has not been studied. The aim of this study was to determine whether exercise echocardiography predicts outcomes in patients with HCM.

Methods

LV function and LVOT gradients were evaluated during exercise echocardiography in 239 patients with HCM.

Results

Sixty patients (25.1%) had LVOT obstruction at rest, and 43 (18%) developed exercise-induced LVOT obstruction. The mean resting LV ejection fraction was 69 ± 9%, and the mean resting wall motion score index was 1.00 ± 0.06. Wall motion abnormalities during exercise were seen in 19 patients (7.9%). During follow-up of 4.1 ± 2.6 years, 19 patients had hard events (cardiac death, cardiac transplantation, appropriate discharge of a defibrillator, stroke, myocardial infarction, or hospitalization for heart failure), and 41 patients had composite end points of hard or soft events (including atrial fibrillation and syncope). Exercise wall motion abnormalities occurred in 31.5% of patients with hard events compared with 5.9% of patients without hard events (P < .001). After adjustment, LV wall thickness (hazard ratio [HR], 1.13; 95% confidence interval [CI], 1.05–1.21; P = .002), resting wall motion score index (HR, 21.59; 95% CI, 2.38–196.1, P = .006), and metabolic equivalents (HR, 0.74; 95% CI, 0.63–0.88; P = .001) remained independent predictors of hard events. Change in wall motion score index was also independently associated with hard events (HR, 52.30; 95% CI, 3.81–718.5; P = .003) and with the composite end point (HR, 39.51; 95% CI, 3.79–412.4; P = .002). LVOT obstruction was not associated with either end point.

Conclusions

Assessment of exercise capacity and LV systolic function during exercise echocardiography may have a role in risk stratification of patients with HCM.

Keywords: Exercise echocardiography, Hypertrophic cardiomyopathy, Regional wall motion abnormalities

Abbreviations: BP, Blood pressure, HCM, Hypertrophic cardiomyopathy, LV, Left ventricular, LVEF, Left ventricular ejection fraction, LVOT, Left ventricular outflow tract, MET, Metabolic equivalent, MR, Mitral regurgitation, SAM, Systolic anterior motion, WMA, Wall motion abnormality, WMSI, Wall motion score index