Rest and Stress Longitudinal Systolic Left Ventricular Mechanics in Hypertrophic Cardiomyopathy: Implications for Prognostication

Iraklis Pozios, Aurelio Pinheiro, Celia Corona Villalobos, Lars L. Sorensen, Zeina Dardari, Hong yun Liu, Kenneth Cresswell, Susan Phillip, David A. Bluemke, Stefan Zimmerman, M. Roselle Abraham, Theodore P. Abraham

Research output: Contribution to journalArticle

Abstract

Background: Exercise intolerance is the most common symptom in hypertrophic cardiomyopathy (HCM). We examined whether inability to augment myocardial mechanics during exercise would influence functional performance and clinical outcomes in HCM. Methods: Ninety-five HCM patients (32 nonobstructive, 32 labile-obstructive, 31 obstructive) and 26 controls of similar age and gender distribution were recruited prospectively. They underwent rest and treadmill stress strain echocardiography, and 61 of them underwent magnetic resonance imaging. Mechanical reserve (MRES) was defined as percent change in systolic strain rate (SR) immediately postexercise. Results: Global strain and SR were significantly lower in HCM patients at rest (strain: nonobstructive, −15.6 ± 3.0; labile-obstructive, −15.9 ± 3.0; obstructive, −13.8 ± 2.9; control, −17.7% ± 2.1%, P < .001; SR: nonobstructive, −0.92 ± 0.20; labile−obstructive, −0.94 ± 0.17; obstructive, −0.85 ± 0.18; control, −1.04 ± 0.14 s−1, P = .002); and immediately postexercise (strain: nonobstructive, −15.6 ± 3.0; labile-obstructive, −17.6 ± 3.6; obstructive, −15.6 ± 3.6; control, −19.2 ± 3.1%; P = .001; SR: nonobstructive, −1.41 ± 0.37; labile-obstructive, −1.64 ± 0.38; obstructive, −1.32 ± 0.29; control, −1.82 ± 0.29 s−1, P < .001). MRES was lower in nonobstructive and obstructive compared with labile-obstructive and controls (51% ± 29%, 54% ± 31%, 78% ± 38%, 77% ± 30%, P = .001, respectively). Postexercise SR and MRES were associated with exercise capacity (r = 0.47 and 0.42, P < .001 both, respectively). When adjusted for age, gender, body mass index, E/e’, and resting peak instantaneous systolic gradient, postexercise SR best predicted exercise capacity (r = 0.74, P = .003). Postexercise SR was correlated with extent of late gadolinium enhancement (r = 0.34, P = .03). By Cox regression, exercise SR and MRES predicted ventricular tachycardia/ventricular fibrillation (VT/VF) even after adjustment for age, gender, family history of sudden cardiac death, septum ≥ 3 cm and abnormal blood pressure response (P = .04 and P = .046, respectively). Conclusions: Nonobstructive and obstructive patients have reduced MRES compared with labile-obstructive and controls. Postexercise SR correlates with LGE and exercise capacity. Exercise SR and MRES predict VT/VF.

Original languageEnglish (US)
JournalJournal of the American Society of Echocardiography
DOIs
StateAccepted/In press - Jan 1 2018

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Hypertrophic Cardiomyopathy
Mechanics
Exercise
Ventricular Fibrillation
Ventricular Tachycardia
Heart Septum
Stress Echocardiography
Sudden Cardiac Death
Age Distribution
Gadolinium
Body Mass Index
Magnetic Resonance Imaging
Blood Pressure

Keywords

  • Arrhythmia
  • Exercise echocardiography
  • Hypertrophic cardiomyopathy
  • Mechanics

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Rest and Stress Longitudinal Systolic Left Ventricular Mechanics in Hypertrophic Cardiomyopathy : Implications for Prognostication. / Pozios, Iraklis; Pinheiro, Aurelio; Corona Villalobos, Celia; Sorensen, Lars L.; Dardari, Zeina; Liu, Hong yun; Cresswell, Kenneth; Phillip, Susan; Bluemke, David A.; Zimmerman, Stefan; Abraham, M. Roselle; Abraham, Theodore P.

In: Journal of the American Society of Echocardiography, 01.01.2018.

Research output: Contribution to journalArticle

Pozios, Iraklis ; Pinheiro, Aurelio ; Corona Villalobos, Celia ; Sorensen, Lars L. ; Dardari, Zeina ; Liu, Hong yun ; Cresswell, Kenneth ; Phillip, Susan ; Bluemke, David A. ; Zimmerman, Stefan ; Abraham, M. Roselle ; Abraham, Theodore P. / Rest and Stress Longitudinal Systolic Left Ventricular Mechanics in Hypertrophic Cardiomyopathy : Implications for Prognostication. In: Journal of the American Society of Echocardiography. 2018.
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title = "Rest and Stress Longitudinal Systolic Left Ventricular Mechanics in Hypertrophic Cardiomyopathy: Implications for Prognostication",
abstract = "Background: Exercise intolerance is the most common symptom in hypertrophic cardiomyopathy (HCM). We examined whether inability to augment myocardial mechanics during exercise would influence functional performance and clinical outcomes in HCM. Methods: Ninety-five HCM patients (32 nonobstructive, 32 labile-obstructive, 31 obstructive) and 26 controls of similar age and gender distribution were recruited prospectively. They underwent rest and treadmill stress strain echocardiography, and 61 of them underwent magnetic resonance imaging. Mechanical reserve (MRES) was defined as percent change in systolic strain rate (SR) immediately postexercise. Results: Global strain and SR were significantly lower in HCM patients at rest (strain: nonobstructive, −15.6 ± 3.0; labile-obstructive, −15.9 ± 3.0; obstructive, −13.8 ± 2.9; control, −17.7{\%} ± 2.1{\%}, P < .001; SR: nonobstructive, −0.92 ± 0.20; labile−obstructive, −0.94 ± 0.17; obstructive, −0.85 ± 0.18; control, −1.04 ± 0.14 s−1, P = .002); and immediately postexercise (strain: nonobstructive, −15.6 ± 3.0; labile-obstructive, −17.6 ± 3.6; obstructive, −15.6 ± 3.6; control, −19.2 ± 3.1{\%}; P = .001; SR: nonobstructive, −1.41 ± 0.37; labile-obstructive, −1.64 ± 0.38; obstructive, −1.32 ± 0.29; control, −1.82 ± 0.29 s−1, P < .001). MRES was lower in nonobstructive and obstructive compared with labile-obstructive and controls (51{\%} ± 29{\%}, 54{\%} ± 31{\%}, 78{\%} ± 38{\%}, 77{\%} ± 30{\%}, P = .001, respectively). Postexercise SR and MRES were associated with exercise capacity (r = 0.47 and 0.42, P < .001 both, respectively). When adjusted for age, gender, body mass index, E/e’, and resting peak instantaneous systolic gradient, postexercise SR best predicted exercise capacity (r = 0.74, P = .003). Postexercise SR was correlated with extent of late gadolinium enhancement (r = 0.34, P = .03). By Cox regression, exercise SR and MRES predicted ventricular tachycardia/ventricular fibrillation (VT/VF) even after adjustment for age, gender, family history of sudden cardiac death, septum ≥ 3 cm and abnormal blood pressure response (P = .04 and P = .046, respectively). Conclusions: Nonobstructive and obstructive patients have reduced MRES compared with labile-obstructive and controls. Postexercise SR correlates with LGE and exercise capacity. Exercise SR and MRES predict VT/VF.",
keywords = "Arrhythmia, Exercise echocardiography, Hypertrophic cardiomyopathy, Mechanics",
author = "Iraklis Pozios and Aurelio Pinheiro and {Corona Villalobos}, Celia and Sorensen, {Lars L.} and Zeina Dardari and Liu, {Hong yun} and Kenneth Cresswell and Susan Phillip and Bluemke, {David A.} and Stefan Zimmerman and Abraham, {M. Roselle} and Abraham, {Theodore P.}",
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TY - JOUR

T1 - Rest and Stress Longitudinal Systolic Left Ventricular Mechanics in Hypertrophic Cardiomyopathy

T2 - Implications for Prognostication

AU - Pozios, Iraklis

AU - Pinheiro, Aurelio

AU - Corona Villalobos, Celia

AU - Sorensen, Lars L.

AU - Dardari, Zeina

AU - Liu, Hong yun

AU - Cresswell, Kenneth

AU - Phillip, Susan

AU - Bluemke, David A.

AU - Zimmerman, Stefan

AU - Abraham, M. Roselle

AU - Abraham, Theodore P.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Exercise intolerance is the most common symptom in hypertrophic cardiomyopathy (HCM). We examined whether inability to augment myocardial mechanics during exercise would influence functional performance and clinical outcomes in HCM. Methods: Ninety-five HCM patients (32 nonobstructive, 32 labile-obstructive, 31 obstructive) and 26 controls of similar age and gender distribution were recruited prospectively. They underwent rest and treadmill stress strain echocardiography, and 61 of them underwent magnetic resonance imaging. Mechanical reserve (MRES) was defined as percent change in systolic strain rate (SR) immediately postexercise. Results: Global strain and SR were significantly lower in HCM patients at rest (strain: nonobstructive, −15.6 ± 3.0; labile-obstructive, −15.9 ± 3.0; obstructive, −13.8 ± 2.9; control, −17.7% ± 2.1%, P < .001; SR: nonobstructive, −0.92 ± 0.20; labile−obstructive, −0.94 ± 0.17; obstructive, −0.85 ± 0.18; control, −1.04 ± 0.14 s−1, P = .002); and immediately postexercise (strain: nonobstructive, −15.6 ± 3.0; labile-obstructive, −17.6 ± 3.6; obstructive, −15.6 ± 3.6; control, −19.2 ± 3.1%; P = .001; SR: nonobstructive, −1.41 ± 0.37; labile-obstructive, −1.64 ± 0.38; obstructive, −1.32 ± 0.29; control, −1.82 ± 0.29 s−1, P < .001). MRES was lower in nonobstructive and obstructive compared with labile-obstructive and controls (51% ± 29%, 54% ± 31%, 78% ± 38%, 77% ± 30%, P = .001, respectively). Postexercise SR and MRES were associated with exercise capacity (r = 0.47 and 0.42, P < .001 both, respectively). When adjusted for age, gender, body mass index, E/e’, and resting peak instantaneous systolic gradient, postexercise SR best predicted exercise capacity (r = 0.74, P = .003). Postexercise SR was correlated with extent of late gadolinium enhancement (r = 0.34, P = .03). By Cox regression, exercise SR and MRES predicted ventricular tachycardia/ventricular fibrillation (VT/VF) even after adjustment for age, gender, family history of sudden cardiac death, septum ≥ 3 cm and abnormal blood pressure response (P = .04 and P = .046, respectively). Conclusions: Nonobstructive and obstructive patients have reduced MRES compared with labile-obstructive and controls. Postexercise SR correlates with LGE and exercise capacity. Exercise SR and MRES predict VT/VF.

AB - Background: Exercise intolerance is the most common symptom in hypertrophic cardiomyopathy (HCM). We examined whether inability to augment myocardial mechanics during exercise would influence functional performance and clinical outcomes in HCM. Methods: Ninety-five HCM patients (32 nonobstructive, 32 labile-obstructive, 31 obstructive) and 26 controls of similar age and gender distribution were recruited prospectively. They underwent rest and treadmill stress strain echocardiography, and 61 of them underwent magnetic resonance imaging. Mechanical reserve (MRES) was defined as percent change in systolic strain rate (SR) immediately postexercise. Results: Global strain and SR were significantly lower in HCM patients at rest (strain: nonobstructive, −15.6 ± 3.0; labile-obstructive, −15.9 ± 3.0; obstructive, −13.8 ± 2.9; control, −17.7% ± 2.1%, P < .001; SR: nonobstructive, −0.92 ± 0.20; labile−obstructive, −0.94 ± 0.17; obstructive, −0.85 ± 0.18; control, −1.04 ± 0.14 s−1, P = .002); and immediately postexercise (strain: nonobstructive, −15.6 ± 3.0; labile-obstructive, −17.6 ± 3.6; obstructive, −15.6 ± 3.6; control, −19.2 ± 3.1%; P = .001; SR: nonobstructive, −1.41 ± 0.37; labile-obstructive, −1.64 ± 0.38; obstructive, −1.32 ± 0.29; control, −1.82 ± 0.29 s−1, P < .001). MRES was lower in nonobstructive and obstructive compared with labile-obstructive and controls (51% ± 29%, 54% ± 31%, 78% ± 38%, 77% ± 30%, P = .001, respectively). Postexercise SR and MRES were associated with exercise capacity (r = 0.47 and 0.42, P < .001 both, respectively). When adjusted for age, gender, body mass index, E/e’, and resting peak instantaneous systolic gradient, postexercise SR best predicted exercise capacity (r = 0.74, P = .003). Postexercise SR was correlated with extent of late gadolinium enhancement (r = 0.34, P = .03). By Cox regression, exercise SR and MRES predicted ventricular tachycardia/ventricular fibrillation (VT/VF) even after adjustment for age, gender, family history of sudden cardiac death, septum ≥ 3 cm and abnormal blood pressure response (P = .04 and P = .046, respectively). Conclusions: Nonobstructive and obstructive patients have reduced MRES compared with labile-obstructive and controls. Postexercise SR correlates with LGE and exercise capacity. Exercise SR and MRES predict VT/VF.

KW - Arrhythmia

KW - Exercise echocardiography

KW - Hypertrophic cardiomyopathy

KW - Mechanics

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