TY - JOUR
T1 - Safety profile and utility of treadmill exercise in patients with high-gradient hypertrophic cardiomyopathy
AU - Sorensen, Lars Lindholm
AU - Liang, Hsin Yueh
AU - Pinheiro, Aurelio
AU - Hilser, Alex
AU - Dimaano, Veronica
AU - Olsen, Niels Thue
AU - Hansen, Thomas Fritz
AU - Sogaard, Peter
AU - Nowbar, Alexandra
AU - Pisanello, Chiara
AU - Pozios, Iraklis
AU - Phillip, Susan
AU - Zhou, Xun
AU - Abraham, Roselle
AU - Abraham, Theodore P.
N1 - Funding Information:
Financial support: This work was supported in part by a grant from the National Institutes of Health ( HL098046 ) and the John Taylor Babbit Foundation. Lars L. Sorensen is supported in part by a grant from Ingenor August Wedell Erichsens legat, Snedkermester Sophus Jacobsen og Hustru Fond, and Direktor Jacob Madsen and Olga Madsens Fond.
Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2017/2/1
Y1 - 2017/2/1
N2 - 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 ≥30 mm 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.
AB - 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 ≥30 mm 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.
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U2 - 10.1016/j.ahj.2016.10.010
DO - 10.1016/j.ahj.2016.10.010
M3 - Article
C2 - 27892886
AN - SCOPUS:84995811873
SN - 0002-8703
VL - 184
SP - 47
EP - 54
JO - American heart journal
JF - American heart journal
ER -