Abstract 1059: Left Atrial Volume and E/E′ Ratio are Most Predictive of Exercise Capacity in Hypertrophic Cardiomyopathy

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Vy-Van Le ◽  
Marco Perez ◽  
Matthew Wheeler ◽  
Ingela Schnittger ◽  
Euan Ashley
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Exercise Capacity ◽  
Functional Limitation ◽  
Left Atrial Volume ◽  
Exercise Group ◽  
Peak Exercise ◽  
Group I ◽  
Significant Difference ◽  
Doppler Indices ◽  
Pattern Group

Hypertrophic cardiomyopathy (HCM) is characterized by LVH and myocardial disarray which result in ischemia, diastolic dysfunction and arrhythmias. While many experience functional limitation, the precise mechanisms are still unknown. We aim to determine the relation between echocardiogram findings and exercise capacity. We studied 48 patients (48 ± 15 years; 15 females) referred for symptom-limited cardiopulmonary testing and stress echocardiography for clinical reasons: 23 had a proximal HCM pattern (group I), 7 had a classic reverse curvature pattern (group II), 4 had an apical pattern (group III) and 14 had a concentric pattern (group IV). At baseline, patients in group I were significantly older than in other groups (54 ± 13 (I) vs. 41 ± 12 (II), 38 ± 12(III) and 44 ± 17 years (IV); p=0.04). No other significant difference in clinical characteristics was noted between groups. The maximal septum thickness was higher in groups I and II than in III and IV (19 (16 – 23), 22 (17–33), 17, and 16 (13–18) mm, respectively; p=0.05). Groups I and II were more likely to have resting gradient of >10 mm Hg (68% and 18%, respectively vs. 14% in IV; p=0.01) and to present rest systolic anterior movement (74% and 15% vs. 11% in IV; p <0.001). A higher prevalence of abnormal transmitral inflow E to lateral E′ ratio (E/E′) was also noted in Group I (80%, p=0.05): high ratios are known to be associated with high pulmonary wedge pressure in non-HCM populations. At peak exercise, group I achieved a lower peak VO 2 (21.8 ±2.1 vs. 27.1±6.6 in II 36.6 ±5.1 in III and 29.4 ±2.7 ml/kg/min in IV; p=0.03). No significant differences in Valsalva and exercise gradients and delta rest-to-peak gradients were noted between patterns. In age-adjusted multivariate analysis, only negative correlations between E/E′ (R2=0.45; p=0.03) and indexed LA volume (R2=0.39; p=0.009) and peak VO 2 were significant. In contrast, no correlation was found between maximal exercise capacity and LV dimensions, conventional Doppler indices of diastolic function, lateral E′ or gradients. Lateral E/E′ and indexed LA volume are negatively correlated with functional capacity even after age-adjustment. Although patients with proximal HCM achieved the lowest peak VO 2 , gradient and morphology were not related to exercise capacity.

Six-month outcomes of a high intensity exercise programme in young patients with hypertrophic cardiomyopathy: The SAFE-HCM trial

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
J Basu ◽  
S Jayakumar ◽  
C Miles ◽  
G Parry-Williams ◽  
H Maclachlan ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
High Intensity ◽  
Young Patients ◽  
Exercise Adherence ◽  
Exercise Programme ◽  
Exercise Group ◽  
Moderate Intensity ◽  
Psychological Benefits ◽  
Significant Difference

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Cardiac Risk in the Young Background Moderate intensity exercise training in older patients with hypertrophic cardiomyopathy (HCM) can improve functional capacity, without significant harm. However, younger patients are attracted to high intensity training (HIT) regimes. The SAFE-HCM study demonstrated that an individually tailored, HIT programme in young patients with HCM was feasible, and provided both health and psychological benefits, without an increase in the burden of arrhythmia. Purpose To assess whether observed benefits of a HIT programme in young patients with HCM are sustained at 6 months. Methods Eighty patients with HCM (45.7y+/-8.6) underwent baseline clinical and psychological assessment. Individuals were randomised to a 12-week HIT programme (n = 40) or usual care (n = 40). Baseline evaluation was repeated at 12 weeks (T12). Feasibility, safety, health and psychological benefits were assessed. At 12-weeks individuals were encouraged to continue with the frequency and intensity of physical activity (PA) achieved at the end of the cardiac rehabilitation programme. Participants in the exercise arm were invited to follow-up at 6 months (T6m). Results The majority (83%) of participants completed the 12-week study. At T12 there was no significant difference between groups in the composite arrhythmia safety outcome (p = 0.99). The indices of exercise capacity were significantly improved in the exercise compared to the control group; peak VO2 (+3.7ml/kg/min [CI 1.1,6.3], p = 0.006), VO2/kg at anaerobic threshold (VO2/kgAT) (+2.44ml/kg/min [CI 0.6,4.2], p = 0.009), time to AT (+115s [CI 54.3,175.9], p &lt; 0.001) and exercise time (max ET) (+108s [CI 33.7,182.2], p = 0.005). The exercise group also demonstrated greater reduction in systolic BP (-7.3mmHg [CI -11.7,-2.8], p = 0.002), BMI (-0.8kg/m2 [CI-1.1,-0.4], p &lt; 0.001), anxiety (-2.6 [CI-3.6,-1.6], p= &lt;0.001) and depression (-1.1 [CI -2.0,-0.2], p = 0.015) scores. At T6m patient reported exercise adherence was comparable to baseline PA in 33/34 of the exercise group attending for follow up. Most exercise gains dissipated with the exception of time to AT (p = 0.002), max ET (p = 0.003), VO2/kgAT (p = 0.04) and anxiety score (p &lt; 0.001) (Figure 1). There were no sustained episodes of atrial or ventricular arrhythmias. The incidence of NSVT did not differ between time points (p = 0.09). Conclusion A 12-week HIT programme in young patients with HCM offers considerable gains in fitness and psychological outcomes, with no increase in arrhythmic burden. At T6m exercise levels as well as most physiological adaptations and health benefits returned to baseline, as seen in other studies when formal participation in an exercise programme comes to an end. This highlights the importance of the implementation of strategies to encourage ongoing engagement in PA. Potential solutions include identification of barriers to exercise, as well as adoption of novel tele-rehabilation approaches. Abstract Figure 1 Sustained benefits at T6m

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 &gt; 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 &lt; 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 &lt; 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.

scholarly journals A photogrammetric and cephalometric evaluation of facial symmetry and smile in relation to attractiveness.

2021 ◽  
Vol 6 (3) ◽  
pp. 1-8
Author(s):  
Akshita ◽  
Arun K. Chauhan ◽  
Riddhi Chawla
Keyword(s):  
Growth Pattern ◽  
Cephalometric Analysis ◽  
Average Growth ◽  
Facial Symmetry ◽  
Photographic Analysis ◽  
Group I ◽  
Cephalometric Radiograph ◽  
Significant Difference ◽  
Horizontal Growth ◽  
Pattern Group

Introduction: Human find symmetrical face more attractive than are asymmetrical faces. The smile is one of the most important facial expressions and is essential in expressing friendliness, agreement, and appreciation. The aim of the present study was to evaluate the relationship between smile and symmetry in attributing to attractiveness.   Materials & Method: The study was conducted in the Department Of Orthodontics and Dentofacial Orthopedics, on 150 samples. 150 good quality radiographs and photographs of the patients were obtained. The subjects were divided into three groups:  Group I – Horizontal growth pattern Group II – Average growth pattern Group III – Vertical growth pattern. The frontal facial photograph and PA cephalometric radiograph were used to assess the facial symmetry. Posed smile photograph and Lateral cephalometric radiograph were used to assess the smile. Digimizer Image Analyzer (bvba software) were used for the analysis. The ratings were given by the expert panellist based on attractiveness   Results: In the present study, Left facial symmetry parameters is marginally higher than right side in cephalometric analysis and converse for photographic analysis, right facial symmetry parameters is marginally higher than left side but this is not statistically significant. There are no statistically significant difference among the groups for smile -photographic parameters and lateral cephalometric smile parameters. There is statistically significant difference among the groups for Visual Analog Scale readings for attractiveness given by orthodontist, general dentist and layperson for frontal profile for the subjects of three study groups.   Conclusion: The study revealed that in cephalometric analysis, left hemiface is wider than right hemiface while in photographic analysis, right hemiface is wider than left hemiface. Vertical grower shows maximum upper incisor exposure and upper and lower vermilion lip thickness. On the contrary full smile length was minimum in vertical grower. The most favored profile by VAS was horizontal growth pattern.

scholarly journals Sex-related differences in exercise performance and outcome of patients with hypertrophic cardiomyopathy

2019 ◽  
Vol 27 (17) ◽  
pp. 1821-1831 ◽  
Author(s):  
Luca Ghiselli ◽  
Alberto Marchi ◽  
Carlo Fumagalli ◽  
Niccolò Maurizi ◽  
Andrea Oddo ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Exercise Capacity ◽  
Exercise Performance ◽  
Cardiac Death ◽  
Predictive Accuracy ◽  
Multivariable Analysis ◽  
Peak Exercise ◽  
Exercise Echocardiography ◽  
Metabolic Equivalents ◽  
Age Related

Aims Exercise performance is known to predict outcome in hypertrophic cardiomyopathy (HCM), but whether sex-related differences exist is unresolved. We explored whether functional impairment, assessed by exercise echocardiography, has comparable predictive accuracy in females and males with HCM. Methods We retrospectively evaluated 292 HCM patients (46 ± 16 years, 72% males), consecutively referred for exercise echocardiography; 242 were followed for 5.9 ± 4.2 years. Results Peak exercise capacity was 6.5 ± 1.6 metabolic equivalents (METs). Sixty patients (21%) showed impaired exercise capacity (≤5 METs). Exercise performance was reduced in females, compared with males (5.6 ± 1.6 vs 6.9 ± 1.5 METs, p < 0.001; peak METs ≤ 5 in 40% vs 13%, p < 0.001), largely driven by a worse performance in women >50 years of age. At multivariable analysis, female sex was independently associated with impaired exercise capacity (odds ratio: 4.67; 95% confidence interval (CI): 1.83–11.90; p = 0.001). During follow-up, 24 patients (10%) met the primary endpoint (a combination of cardiac death, heart failure requiring hospitalization, sustained ventricular tachycardia, appropriate implantable cardioverter defibrillator discharge, resuscitated sudden cardiac death and cardioembolic stroke). Event-free survival was reduced in females ( p = 0.035 vs males). Peak METs were inversely related to outcome in males (hazard ratio (HR) per unit increase: 0.57; 95% CI: 0.39–0.84; p = 0.004) but not in females (HR: 1.22; 95% CI: 0.66–2.24; p = 0.53). Conclusions Female patients with HCM showed significant age-related impairment in functional capacity compared with males, particularly evident in post-menopausal age groups. While women were at greater risk of HCM-related complications and death, impaired exercise capacity predicted adverse outcome only in men. These findings suggest the need for sex-specific management strategies in HCM.

Abstract 17141: Mavacamten Improves Left Ventricular Relaxation and Compliance in Obstructive Hypertrophic Cardiomyopathy Through Direct Myosin Modulation

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Stephen Heitner ◽  
Daniel Jacoby ◽  
Steven Lester ◽  
Anjali T Owens ◽  
Andrew Wang ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Exercise Capacity ◽  
Left Ventricular ◽  
Open Label ◽  
End Diastolic Volume ◽  
Concomitant Reduction ◽  
Obstructive Hypertrophic Cardiomyopathy ◽  
Healthy Dogs ◽  
Cross Bridges ◽  
Doppler Indices

Introduction: Obstructive hypertrophic cardiomyopathy (oHCM) consists of a constellation of LV hypercontractility, LV outflow tract obstruction (LVOTO), and impaired relaxation, often resulting in dyspnea and reduced exercise capacity. In healthy dogs, the novel myosin modulator mavacamten (MAVA), decreased LV hypercontractility and improved compliance. In the PIONEER-HCM clinical study, improvements in post-exercise LVOT gradient, exercise capacity, and symptoms were reported. To examine whether MAVA could also limit residual myosin-actin cross-bridges during diastole, and improve LV compliance, its effects on diastolic indices were evaluated. Methods: In PIONEER-HCM, an open-label, multi-site, prospective study, oHCM subjects received MAVA for 12 weeks at either 10-20 mg/d (n = 11, Cohort A; 10 completed) or at 2-5 mg/d (n = 10, Cohort B). Echo-Doppler indices of LV filling and relaxation were compared at baseline to week 12. The p-values are from Wilcoxon signed rank tests, evaluating the distribution of within-subject 12-wk changes from baseline around a null of zero. Results: MAVA reduced hypercontractility in a dose-dependent fashion, with relief of LVOTO in all subjects achieving plasma MAVA concentration >350 ng/ml (data previously reported). There was also an increase in mitral annular velocity during early diastole (e’ lat ). There was a concomitant reduction in E/e’ lat and increase in LV end-diastolic volume (LVEDV) consistent with improved LV compliance (Table). MAVA improved dyspnea score with a trend towards reduction in NT-proBNP. Conclusions: Administration of MAVA is associated with improvement in measures of myocardial relaxation (e’ lat ) and compliance in parallel with reduction in LVOT gradient. These findings are consistent with preclinical findings reported in healthy dogs and support additional evaluation of MAVA in patients with obstructive or non-obstructive HCM.

Exercise capacity is associated with rest and peak-exercise left ventricular global longitudinal strain in patients with hypertrophic cardiomyopathy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.M Fava ◽  
A Alashi ◽  
Y Saijo ◽  
I Sande Mathias ◽  
Z Popovic ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Left Ventricle ◽  
Exercise Capacity ◽  
Myocardial Dysfunction ◽  
Global Longitudinal Strain ◽  
Myocardial Strain ◽  
Left Ventricular ◽  
Peak Exercise ◽  
Left Ventricle Mass ◽  
Metabolic Equivalents

Abstract Background Patients with hypertrophic cardiomyopathy (HCM) frequently have reduced exercise capacity, which can be associated with subclinical cardiac dysfunction. Left ventricle global myocardial strain (LV-GLS) is a sensitive index to detect subclinical myocardial dysfunction. However, the clinical utility of LV-GLS during exercise test remains uncertain. Purpose We assessed the association of functional capacity with LV-GLS at rest and at the peak of stress in HCM patients. Methods We examined 566 asymptomatic/minimally symptomatic HCM patients (54±14 years, 57% men, body mass index 30±6 kg/m2, 84% on beta-blockers) by echo at rest and following maximal exercise. We recorded clinical, echo variables (LV ejection fraction [LVEF], LV thickness, left ventricle mass index [LVMI], left ventricle outflow tract [LVOT] gradient, LV-GLS at rest and at peak stress), and exercise variables (percent of age-gender predicted metabolic equivalents [AGP-METs]). Results Echo parameters were as follows: LVEF at rest of 62±6%, wall thickness of 16.9±0.4 mm, LVMI of 117±47 g/m2, LVOT gradient at rest of 27±33 mmHg, LV-GLS at rest of −15.9±3.6%, LV-GLS at peak of stress of −17.4±4.3%, and change in LV strain from rest to stress of −1.9±2.3%. Only 41% of patients achieved &gt;85% of AGP-METs. Logistic regression demonstrating an association between AGP-METs less than 85% and various predictors are shown in Table 1. Conclusion Impaired deformation at peak of stress assessed by LV-GLS was associated with reduced exercise capacity measured as AGP-METs less than 85%. These findings suggest that early systolic cardiac deterioration should be considered as a cause of exercise impairment in patients with HCM. Funding Acknowledgement Type of funding source: None

Two Models of Hypoxia on Rat Myocardial Aerobic Metabolism Ability

2014 ◽  
Vol 926-930 ◽  
pp. 1132-1135
Author(s):  
Qiao Zhen Yan
Keyword(s):  
Intermittent Hypoxia ◽  
Exercise Group ◽  
Male Rats ◽  
Control Group ◽  
Ventricular Wall ◽  
Low Oxygen ◽  
Practice Group ◽  
Hypoxia Group ◽  
Group I ◽  
Significant Difference

The influence on rat myocardial aerobic capacity about IHT and Hilo.48 eight weeks SD male rats 48 for adaptability training a week later randomly divided into 6 groups,Control group (C), the exercise group (S), intermittent hypoxia group (I), intermittent hypoxia training (IS), high living in control group (H) and high live low practice group (HS),each group of eight.training group,aerobic exercise every day.Hypoxia group, hypoxic stimulus and hypoxia group three times a week,training load increasing every week.Partial slaughter after training,get the rat myocardial SDH and CCO respectively,measure its activity.Take the rat heart,test the rat ventricular wall thickness.After text:The SDH of myocardial have a very significant difference in S、I、IS、H、HS;The CCO of myocardial have a very significant difference in S、I、IS、H HS;Conclusion:The two kinds of low oxygen can improve the rat myocardial SDH and CCO,in this research IHT is superior to Hilo.

Abstract 15765: Clinical Significance of Submaximal Parameters of Exercise Stress Test in Characterizing Post-Fontan Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Daphney Kernizan ◽  
Gina DAloisio ◽  
Bradley Robinson ◽  
Takeshi Tsuda
Keyword(s):  
Exercise Capacity ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Cycle Ergometer ◽  
Exercise Stress ◽  
Peak Oxygen Consumption ◽  
Peak Exercise ◽  
Fontan Patient ◽  
Significant Difference ◽  
Fontan Patients

Background: Fontan patients have diminished exercise capacity relative to healthy peers. Peak oxygen consumption (pVO2) is a useful marker for maximum exercise capacity, though it may not be achievable in certain patients. We studied clinical validity of submaximal parameters in exercise stress test (EST) in post-Fontan patients. Methods: We retrospectively analyzed EST of post-Fontan patients and age-matched controls by cycle ergometer. We obtained peak values of heart rate (pHR), VO2, oxygen pulse (pOP), respiratory quotient (pRQ), and work rate (pWR). Submaximal parameters included ventilatory anaerobic threshold (VAT), slopes of VO2/HR changes (ΔVO2/ΔHR) and HR/WR changes (ΔHR/ΔWR), and oxygen uptake efficiency slope (OUES). Data are shown as mean ± standard deviation. Results: Twenty four single right ventricle (SRV), 12 single left ventricle (SLV), and 24 controls were studied (Table 1).pHR, pVO2, pOP, and pWR were significantly lower in Fontan patients than in controls, but with no significant difference between SRV and SLV. ΔVO2/ΔHR and OUES were significantly lower in Fontan group than controls, whereas VAT and pRQ were comparable in all three groups. VAT was preserved in Fontan groups. Lower slope of ΔVO2/ΔHR and decreased OUES in the Fontan group suggests an intrinsic exercise limitation or limited stroke volume (SV) increase. This was compensated by a higher HR response up to AT, exhibited by the higher slope of ΔHR/ΔWR despite lower pHR in the Fontan group. Conclusions: Peak exercise parameters were significantly lower in Fontan patients although pRQ and VAT were comparable among the three groups. The lower ΔVO2/ΔHR and pOP in Fontan patients suggest limited SV reserve in response to exercise. A combination of lower ΔVO2/ΔHR and higher ΔHR/ΔWR characterizes Fontan patient. Inclusion of submaximal exercise parameters brings additional value in specifying the physiological responses to exercise.

P888Left ventricular diastolic function and left atrial longitudinal function during exercise correlate with exercise capacity in patients with hypertrophic cardiomyopathy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Rosca ◽  
D Ciuperca ◽  
L Mandes ◽  
A Calin ◽  
C Beladan ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Diastolic Function ◽  
Exercise Capacity ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Exercise Heart Rate ◽  
Systolic Pulmonary Artery Pressure ◽  
Metabolic Equivalents

Abstract Background The clinical course of hypertrophic cardiomyopathy (HCM) is heterogeneous and the development of heart failure (HF) is difficult to predict. Exercise echocardiography can provide information about mechanisms involved in the occurrence of HF symptoms: development of intraventricular obstruction, increase in mitral regurgitation (MR) severity, impaired left ventricular (LV) and left atrial (LA) function. Purpose To analyse the changes in LV and LA function during exercise and to identify the main correlates of exercise capacity in patients (pts) with HCM, in sinus rhythm and with normal LV ejection fraction. Methods We have prospectively enrolled 32 pts (48±17 years, 15 men) with HCM and no obstruction at rest. A symptom limited exercise echocardiogram was performed in all pts using a table ergometer. Maximum LV wall thickness (LVWT), indexed left atrial volume (LAVi), septal E', E/septal E' ratio, were measured at rest (r) and during exercise (e). Global longitudinal LV strain (GLS) and LA strain (LAɛ) were assessed by speckle tracking echocardiography at rest and during exercise. The peak LV outflow tract gradient, systolic pulmonary artery pressure (PAP), and MR degree were recorded at rest and during exercise. Exercise-related symptoms, peak exercise heart rate (HR) and exercise capacity calculated in metabolic equivalents (METs) were also recorded. Results The mean value of achieved METs was 5.9±1.4, the peak HR was 124±25 bpm, representing 72±12% of maximal HR, during a mean of 8.5±2.5 minutes of exercise. Thirteen pts developed LV gradients >30 mmHg. Fifteen pts were asymptomatic, while 17 pts reported dyspnea during exercise. There were no significant differences between pts with and without symptoms regarding: age, rE', rE/E', rGLS, rLAɛ, rMR, rPAP, LAVi, eE/e', eGLS, eMR, ePAP (p>0.05 for all). Symptomatic pts had lower values for eE' (p=0.01), eLAɛ (p=0.03) and tended to have higher values for LVWT (p=0.06) and a higher prevalence of eLV outflow tract obstruction (p=0.13) compared to asymptomatic pts. In symptomatic group of pts, E' (p=0.004), PAP (p<0.001) and GLS (p=0.04) significantly increased and LAɛ tended to decrease (p=0.18) during exercise. Age (r=−0.44, p=0.01), rE' (r=0.40, p=0.02), eE' (r=0.46, p=0.01), ePAP (r=−0.35, p=0.04) and LVWT (r=−0.32, p=0.07) significantly correlated with achieved METs in HCM pts overall. In multivariate analysis, eE' (β=0.60, 95% CI 0.122 to 0.009, p=0.003) was the only parameter independently correlated with exercise capacity (expressed in METs). Conclusions Symptomatic pts had a worse LV diastolic function (as expressed by E') and a severe LA longitudinal dysfunction (as expressed by LAɛ) during exercise. E' during exercise was the only parameter independently correlated with exercise capacity in pts with HCM. These suggest that a detailed analysis of LV and LA function during exercise could provide additional information to predict the occurrence of HF in HCM pts.

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