Exercise-QTc is associated with diffuse interstitial fibrosis reflected by lower approximated T1 relaxation time in hypertrophic cardiomyopathy patients

Celia P. Corona-Villalobos, Sudip Saha, Iraklis Pozios, David Hurtado-de-Mendoza Paz, Lars Sorensen, Jorge Gonzalez Cordoba, Ketty Dolores-Cerna, Ihab R. Kamel, Wilfredo Mormontoy Laurel, David A. Bluemke, Theodore P. Abraham, Stefan L. Zimmerman, M. Roselle Abraham

Research output: Research - peer-reviewArticle

Abstract

Hypertrophic cardiomyopathy (HCM) is frequently associated with exercise-related sudden death. One possible contributor to arrhythmias is pathologic hypertrophy, which can lead to QTc prolongation. Since β-adrenergic stimulation increases inward ionic currents and can increase spatial repolarization heterogeneity, we hypothesized that exercise would prolong QTc and predispose to arrhythmias in HCM patients. We tested this hypothesis by measuring QTc at rest and peak exercise, and examining ECGs for arrhythmias during exercise/recovery in 163 patients with a clinical diagnosis of HCM. Since hypertrophy and fibrosis are risk factors for arrhythmias in HCM, left ventricular (LV) mass and cardiac fibrosis were quantified using cardiac magnetic resonance imaging. Exercise led to an increase in QTc interval (436. ±. 37 to 482. ±. 45, p <. 0.001), QRS duration (100. ±. 9 to 109. ±. 12, p <. 0.001) and ST-T abnormalities. The proportion of patients with QTc prolongation (>470. ms) increased from 28% at rest, to 58% at peak exercise. An inverse correlation was detected between the approximated T1 relaxation time (using the Look-Locker sequence) and rest-QTc (r = -0.68, p <. 0.001); this association was increased during exercise (r = -0.81, p <. 0.001). Late gadolinium enhancement (LGE) and LV mass were weakly associated with exercise-QTc. A weak inverse correlation was also observed between approximated T1 relaxation time and rest/exercise-QRS duration. A trend for association with arrhythmia (non-sustained ventricular tachycardia on Holter) was observed for rest-QTc. >470. ms (OR = 3.0; p = 0.06). We conclude that exercise leads to QTc prolongation in a subset of HCM patients. The association between the approximated T1 relaxation time and QTc interval may reflect concomitant electrical and structural remodeling in HCM.

LanguageEnglish (US)
JournalJournal of Electrocardiology
DOIs
StateAccepted/In press - 2017

Fingerprint

Hypertrophic Cardiomyopathy
Fibrosis
Exercise
Cardiac Arrhythmias
Hypertrophy
Atrial Remodeling
Gadolinium
Ventricular Tachycardia
Sudden Death
Adrenergic Agents
Electrocardiography
Magnetic Resonance Imaging

Keywords

  • Cardiac magnetic resonance
  • Exercise-QTc interval
  • Fibrosis
  • Hypertrophic cardiomyopathy
  • Rest-QTc interval

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Corona-Villalobos, C. P., Saha, S., Pozios, I., Hurtado-de-Mendoza Paz, D., Sorensen, L., Gonzalez Cordoba, J., ... Abraham, M. R. (2017). Exercise-QTc is associated with diffuse interstitial fibrosis reflected by lower approximated T1 relaxation time in hypertrophic cardiomyopathy patients. Journal of Electrocardiology. DOI: 10.1016/j.jelectrocard.2017.02.002

Exercise-QTc is associated with diffuse interstitial fibrosis reflected by lower approximated T1 relaxation time in hypertrophic cardiomyopathy patients. / Corona-Villalobos, Celia P.; Saha, Sudip; Pozios, Iraklis; Hurtado-de-Mendoza Paz, David; Sorensen, Lars; Gonzalez Cordoba, Jorge; Dolores-Cerna, Ketty; Kamel, Ihab R.; Mormontoy Laurel, Wilfredo; Bluemke, David A.; Abraham, Theodore P.; Zimmerman, Stefan L.; Abraham, M. Roselle.

In: Journal of Electrocardiology, 2017.

Research output: Research - peer-reviewArticle

Corona-Villalobos, CP, Saha, S, Pozios, I, Hurtado-de-Mendoza Paz, D, Sorensen, L, Gonzalez Cordoba, J, Dolores-Cerna, K, Kamel, IR, Mormontoy Laurel, W, Bluemke, DA, Abraham, TP, Zimmerman, SL & Abraham, MR 2017, 'Exercise-QTc is associated with diffuse interstitial fibrosis reflected by lower approximated T1 relaxation time in hypertrophic cardiomyopathy patients' Journal of Electrocardiology. DOI: 10.1016/j.jelectrocard.2017.02.002
Corona-Villalobos, Celia P. ; Saha, Sudip ; Pozios, Iraklis ; Hurtado-de-Mendoza Paz, David ; Sorensen, Lars ; Gonzalez Cordoba, Jorge ; Dolores-Cerna, Ketty ; Kamel, Ihab R. ; Mormontoy Laurel, Wilfredo ; Bluemke, David A. ; Abraham, Theodore P. ; Zimmerman, Stefan L. ; Abraham, M. Roselle. / Exercise-QTc is associated with diffuse interstitial fibrosis reflected by lower approximated T1 relaxation time in hypertrophic cardiomyopathy patients. In: Journal of Electrocardiology. 2017
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abstract = "Hypertrophic cardiomyopathy (HCM) is frequently associated with exercise-related sudden death. One possible contributor to arrhythmias is pathologic hypertrophy, which can lead to QTc prolongation. Since β-adrenergic stimulation increases inward ionic currents and can increase spatial repolarization heterogeneity, we hypothesized that exercise would prolong QTc and predispose to arrhythmias in HCM patients. We tested this hypothesis by measuring QTc at rest and peak exercise, and examining ECGs for arrhythmias during exercise/recovery in 163 patients with a clinical diagnosis of HCM. Since hypertrophy and fibrosis are risk factors for arrhythmias in HCM, left ventricular (LV) mass and cardiac fibrosis were quantified using cardiac magnetic resonance imaging. Exercise led to an increase in QTc interval (436. ±. 37 to 482. ±. 45, p <. 0.001), QRS duration (100. ±. 9 to 109. ±. 12, p <. 0.001) and ST-T abnormalities. The proportion of patients with QTc prolongation (>470. ms) increased from 28% at rest, to 58% at peak exercise. An inverse correlation was detected between the approximated T1 relaxation time (using the Look-Locker sequence) and rest-QTc (r = -0.68, p <. 0.001); this association was increased during exercise (r = -0.81, p <. 0.001). Late gadolinium enhancement (LGE) and LV mass were weakly associated with exercise-QTc. A weak inverse correlation was also observed between approximated T1 relaxation time and rest/exercise-QRS duration. A trend for association with arrhythmia (non-sustained ventricular tachycardia on Holter) was observed for rest-QTc. >470. ms (OR = 3.0; p = 0.06). We conclude that exercise leads to QTc prolongation in a subset of HCM patients. The association between the approximated T1 relaxation time and QTc interval may reflect concomitant electrical and structural remodeling in HCM.",
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T1 - Exercise-QTc is associated with diffuse interstitial fibrosis reflected by lower approximated T1 relaxation time in hypertrophic cardiomyopathy patients

AU - Corona-Villalobos,Celia P.

AU - Saha,Sudip

AU - Pozios,Iraklis

AU - Hurtado-de-Mendoza Paz,David

AU - Sorensen,Lars

AU - Gonzalez Cordoba,Jorge

AU - Dolores-Cerna,Ketty

AU - Kamel,Ihab R.

AU - Mormontoy Laurel,Wilfredo

AU - Bluemke,David A.

AU - Abraham,Theodore P.

AU - Zimmerman,Stefan L.

AU - Abraham,M. Roselle

PY - 2017

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N2 - Hypertrophic cardiomyopathy (HCM) is frequently associated with exercise-related sudden death. One possible contributor to arrhythmias is pathologic hypertrophy, which can lead to QTc prolongation. Since β-adrenergic stimulation increases inward ionic currents and can increase spatial repolarization heterogeneity, we hypothesized that exercise would prolong QTc and predispose to arrhythmias in HCM patients. We tested this hypothesis by measuring QTc at rest and peak exercise, and examining ECGs for arrhythmias during exercise/recovery in 163 patients with a clinical diagnosis of HCM. Since hypertrophy and fibrosis are risk factors for arrhythmias in HCM, left ventricular (LV) mass and cardiac fibrosis were quantified using cardiac magnetic resonance imaging. Exercise led to an increase in QTc interval (436. ±. 37 to 482. ±. 45, p <. 0.001), QRS duration (100. ±. 9 to 109. ±. 12, p <. 0.001) and ST-T abnormalities. The proportion of patients with QTc prolongation (>470. ms) increased from 28% at rest, to 58% at peak exercise. An inverse correlation was detected between the approximated T1 relaxation time (using the Look-Locker sequence) and rest-QTc (r = -0.68, p <. 0.001); this association was increased during exercise (r = -0.81, p <. 0.001). Late gadolinium enhancement (LGE) and LV mass were weakly associated with exercise-QTc. A weak inverse correlation was also observed between approximated T1 relaxation time and rest/exercise-QRS duration. A trend for association with arrhythmia (non-sustained ventricular tachycardia on Holter) was observed for rest-QTc. >470. ms (OR = 3.0; p = 0.06). We conclude that exercise leads to QTc prolongation in a subset of HCM patients. The association between the approximated T1 relaxation time and QTc interval may reflect concomitant electrical and structural remodeling in HCM.

AB - Hypertrophic cardiomyopathy (HCM) is frequently associated with exercise-related sudden death. One possible contributor to arrhythmias is pathologic hypertrophy, which can lead to QTc prolongation. Since β-adrenergic stimulation increases inward ionic currents and can increase spatial repolarization heterogeneity, we hypothesized that exercise would prolong QTc and predispose to arrhythmias in HCM patients. We tested this hypothesis by measuring QTc at rest and peak exercise, and examining ECGs for arrhythmias during exercise/recovery in 163 patients with a clinical diagnosis of HCM. Since hypertrophy and fibrosis are risk factors for arrhythmias in HCM, left ventricular (LV) mass and cardiac fibrosis were quantified using cardiac magnetic resonance imaging. Exercise led to an increase in QTc interval (436. ±. 37 to 482. ±. 45, p <. 0.001), QRS duration (100. ±. 9 to 109. ±. 12, p <. 0.001) and ST-T abnormalities. The proportion of patients with QTc prolongation (>470. ms) increased from 28% at rest, to 58% at peak exercise. An inverse correlation was detected between the approximated T1 relaxation time (using the Look-Locker sequence) and rest-QTc (r = -0.68, p <. 0.001); this association was increased during exercise (r = -0.81, p <. 0.001). Late gadolinium enhancement (LGE) and LV mass were weakly associated with exercise-QTc. A weak inverse correlation was also observed between approximated T1 relaxation time and rest/exercise-QRS duration. A trend for association with arrhythmia (non-sustained ventricular tachycardia on Holter) was observed for rest-QTc. >470. ms (OR = 3.0; p = 0.06). We conclude that exercise leads to QTc prolongation in a subset of HCM patients. The association between the approximated T1 relaxation time and QTc interval may reflect concomitant electrical and structural remodeling in HCM.

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KW - Rest-QTc interval

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