Prevalence, determinants, and prognostic significance of exercise-induced pulmonary hypertension in patients with hypertrophic cardiomyopathy

2019 ◽  
Vol 35 (5) ◽  
pp. 837-844
Author(s):  
Yasuhiro Hamatani ◽  
Makoto Amaki ◽  
Rika Yonezawa ◽  
Yoshiki Yanagi ◽  
Yoshito Jo ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Hypertrophic Cardiomyopathy ◽  
Prognostic Significance ◽  
Exercise Induced

scholarly journals 587 Exercise induced pulmonary hypertension in hypertrophic cardiomyopathy: a combined cardiopulmonary exercise test-echocardiographic study

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Federica Re ◽  
Geza Halasz ◽  
Francesco Moroni ◽  
Matteo Beltrami ◽  
Pasquale Baratta ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Hypertrophic Cardiomyopathy ◽  
Exercise Test ◽  
Functional Limitation ◽  
Prognostic Significance ◽  
Cardiopulmonary Exercise Test ◽  
Left Ventricular ◽  
Peak Exercise ◽  
Cardiopulmonary Exercise ◽  
Exercise Induced

Abstract Aims Pulmonary arterial hypertension (PAH) has been described in patients with hypertrophic cardiomyopathy (HCM) and it was associated with a worse prognosis. Nevertheless in most HCM patients, despite normal pulmonary pressures at rest, congestive symptoms are elicited by exercise. In the present study, combining cardiopulmonary exercise test (CPET) with echocardiography, we aimed to evaluate the presence of exercise-induced pulmonary hypertension (EiPAH) its role in functional limitation and its prognostic significance in a cohort of patients with obstructive and non-obstructive HCM. Methods and results 182 HCM patients (35% females, mean age 47.5 ± 15.9) undergoing CPET. During CPET, LVOT velocities and trans-tricuspid gradient were measured. Thirty-seven patients (20%) developed sPAP > 40 mmHg at peak exercise (EiPAH). EiPAH was associated with an lower exercise performance, larger left atrial volumes, higher left ventricular gradient and higher VE/VCO2 slope .At multivariable model baseline sPAP (P < 0.0001) and baseline left ventricular obstruction (LVOT) (P = 0.028) were significantly associated with EiPAH .Kaplan-Meier curve analysis showed EiPAH was a significant predictor of HCM –related morbidity (hazards ratio: 6.21, 95% CI: 1.47–26.19; P = 0.05; 4.21, 95% CI: 1.94–9.12; P < 0.001) for the primary and the secondary endpoint respectively. Conclusions EiPAH was present in about one fifth of HCM patients without evidence of elevated pulmonary pressures at rest, and was associated with adverse clinical outcome. Diagnosing EiPAH by exercise echo/CPET may help physicians to detect early stage of PAH requiring a closer clinical monitoring and individualized treatment strategies.

Prognostic Significance of Exercise Induced Arrhythmias and Echocardiographic Variables in Hypertrophic Cardiomyopathy

2007 ◽  
Vol 99 (6) ◽  
pp. 835-838 ◽  
Author(s):  
T. Jared Bunch ◽  
Krishnaswamy Chandrasekaran ◽  
Jo-Ellen Ehrsam ◽  
Stephen C. Hammill ◽  
Lynn H. Urban ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Prognostic Significance ◽  
Exercise Induced

P4406Significance of exercise-induced pulmonary hypertension in patients with hypertrophic cardiomyopathy

2018 ◽  
Vol 39 (suppl_1) ◽  
Author(s):  
Y Hamatani ◽  
M Amaki ◽  
H Kanzaki ◽  
Y Yanagi ◽  
R Yonezawa ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Hypertrophic Cardiomyopathy ◽  
Exercise Induced

scholarly journals Isolated Exercise-Induced Pulmonary Hypertension Associates with Higher Cardiovascular Risk in Scleroderma Patients

2020 ◽  
Vol 9 (6) ◽  
pp. 1910
Author(s):  
Rosalinda Madonna ◽  
Riccardo Morganti ◽  
Francesco Radico ◽  
Piergiusto Vitulli ◽  
Marco Mascellanti ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Cardiovascular Risk ◽  
Risk Score ◽  
Exercise Test ◽  
Prognostic Significance ◽  
Cardiopulmonary Exercise Test ◽  
Right Atrial ◽  
Cardiopulmonary Exercise ◽  
Exercise Induced ◽  
Clinical Worsening

Background and Aim: Isolated exercise-induced pulmonary hypertension (ExPH) associates with cardiovascular (CV) events in patients with left heart disease. We investigated its prognostic significance in scleroderma patients at risk for pulmonary arterial hypertension (PAH). Methods: In 26 consecutive scleroderma female patients with either low (n = 13) or intermediate probability (n = 13) of pulmonary hypertension (PH) at rest, we evaluated, both at time 0 and 1 year, prognostic determinants of CV risk: onset or progression of heart failure/syncope; worsening of functional class; functional performance at the 6-minute walking test and at cardiopulmonary exercise test; right atrial area; and pericardial effusion. We assigned a severity score 1–3 to each prognostic determinant, derived an overall CV risk score, and its 0–1 year change. Isolated ExPH during the cardiopulmonary exercise test (CPET) was defined as absence of PH at rest, reduced peak VO2, VE/VCO2 >30 at anaerobic threshold, reduced O2 pulse, and ΔVO2/ΔW <9 mL/min/W. We then correlated ExPH at time 0 with clinical worsening (risk score increase >20% after 1 year). Results: ExPH was strongly associated with clinical worsening compared to patients without ExPH (p = 0.005). In patients without ExPH, none had > 20% increased CV risk score after 1 year. Conversely, about 50% of patients with ExPH had such an increase, suggesting a worsening of prognosis. Conclusions: Isolated ExPH associates with higher cardiovascular risk and thus clinical worsening in scleroderma patients. The assessment of ExPH by CPET can thus contribute to a better risk stratification and the planning of a more adequate follow-up.

scholarly journals STRAIN AND EXERCISE INDUCED PULMONARY HYPERTENSION

2021 ◽  
Vol 77 (18) ◽  
pp. 1341
Author(s):  
Christine P. Shen ◽  
Samantha Bagsic ◽  
Rajeev Mohan ◽  
Ajay Srivastava ◽  
J. Thomas Heywood ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Exercise Induced

scholarly journals EXERCISE INDUCED PULMONARY HYPERTENSION IN SARCOIDOSIS

2021 ◽  
Vol 77 (18) ◽  
pp. 1917
Author(s):  
Christine P. Shen ◽  
Ajay Srivastava ◽  
Jacqueline Chang ◽  
Amitabh Pandey
Keyword(s):  
Pulmonary Hypertension ◽  
Exercise Induced

scholarly journals Prognostic significance of cardiac magnetic resonance-based markers in patients with hypertrophic cardiomyopathy

2021 ◽  
Author(s):  
Zsofia Dohy ◽  
Liliana Szabo ◽  
Attila Toth ◽  
Csilla Czimbalmos ◽  
Rebeka Horvath ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Hypertrophic Cardiomyopathy ◽  
Magnetic Resonance ◽  
Myocardial Fibrosis ◽  
Ventricular Arrhythmias ◽  
Prognostic Significance ◽  
Strain Analysis ◽  
Left Ventricular ◽  
Icd Therapy ◽  
Lv Mass

AbstractThe prognosis of patients with hypertrophic cardiomyopathy (HCM) varies greatly. Cardiac magnetic resonance (CMR) is the gold standard method for assessing left ventricular (LV) mass and volumes. Myocardial fibrosis can be noninvasively detected using CMR. Moreover, feature-tracking (FT) strain analysis provides information about LV deformation. We aimed to investigate the prognostic significance of standard CMR parameters, myocardial fibrosis, and LV strain parameters in HCM patients. We investigated 187 HCM patients who underwent CMR with late gadolinium enhancement and were followed up. LV mass (LVM) was evaluated with the exclusion and inclusion of the trabeculae and papillary muscles (TPM). Global LV strain parameters and mechanical dispersion (MD) were calculated. Myocardial fibrosis was quantified. The combined endpoint of our study was all-cause mortality, heart transplantation, malignant ventricular arrhythmias and appropriate implantable cardioverter defibrillator (ICD) therapy. The arrhythmia endpoint was malignant ventricular arrhythmias and appropriate ICD therapy. The LVM index (LVMi) was an independent CMR predictor of the combined endpoint independent of the quantification method (p < 0.01). The univariate predictors of the combined endpoint were LVMi, global longitudinal (GLS) and radial strain and longitudinal MD (MDL). The univariate predictors of arrhythmia events included LVMi and myocardial fibrosis. More pronounced LV hypertrophy was associated with impaired GLS and increased MDL. More extensive myocardial fibrosis correlated with impaired GLS (p < 0.001). LVMi was an independent CMR predictor of major events, and myocardial fibrosis predicted arrhythmia events in HCM patients. FT strain analysis provided additional information for risk stratification in HCM patients.

Refractory exercise-induced severe mitral regurgitation in a patient with hypertrophic cardiomyopathy

2021 ◽  
Author(s):  
Masaki Ishiyama ◽  
Emiyo Sugiura ◽  
Hisato Ito ◽  
Hiroshi Nakajima ◽  
Tairo Kurita ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Mitral Regurgitation ◽  
Severe Mitral Regurgitation ◽  
Exercise Induced
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