Safety profile and utility of treadmill exercise in patients with high-gradient hypertrophic cardiomyopathy.
Am Heart J
; 184: 47-54, 2017 02.
Article
em En
| MEDLINE
| ID: mdl-27892886
ABSTRACT
BACKGROUND:
Exercise echocardiography in the evaluation of hypertrophic cardiomyopathy (HCM) provides valuable information for risk stratification, selection of optimal treatment, and prognostication. However, HCM patients with left ventricular outflow tract gradients ≥30mm Hg are often excluded from exercise testing because of safety considerations. We examined the safety and utility of exercise testing in patients with high-gradient HCM.METHODS:
We evaluated clinical characteristics, hemodynamics, and imaging variables in 499 consecutive patients with HCM who performed 959 exercise tests. Patients were divided based on peak left ventricular outflow tract gradients using a 30-mm Hg threshold into the following obstructive (n=152), labile-obstructive (n=178), and nonobstructive (n=169) groups.RESULTS:
There were no deaths during exercise testing. We noted 20 complications (2.1% of tests) including 3 serious ventricular arrhythmias (0.3% of tests). There was no difference in complication rate between groups. Patients with obstructive HCM had a higher frequency of abnormal blood pressure response (obstructive 53% vs labile obstructive 41% and nonobstructive 37%; P=.008). Obstructive patients also displayed a lower work capacity (obstructive 8.4±3.4 vs labile obstructive 10.9±4.2 and nonobstructive 10.2±4.0, metabolic equivalent; P<.001). Exercise testing provided incremental information regarding sudden cardiac death risk in 19% of patients with high-gradient HCM, and we found a poor correlation between patient-reported functional class and work capacity.CONCLUSION:
Our results suggest that exercise testing in HCM is safe, and serious adverse events are rare. Although numbers are limited, exercise testing in high-gradient HCM appears to confer no significant additional safety hazard in our selected cohort and could potentially provide valuable information.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Arritmias Cardíacas
/
Síncope
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Cardiomiopatia Hipertrófica
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Obstrução do Fluxo Ventricular Externo
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Ecocardiografia sob Estresse
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Teste de Esforço
Tipo de estudo:
Etiology_studies
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Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
/
Aged
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Female
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Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Am Heart J
Ano de publicação:
2017
Tipo de documento:
Article
País de afiliação:
Dinamarca