Abnormal blood-pressure response to exercise and oxygen consumption in patients with hypertrophic cardiomyopathy

Quirino Ciampi, Sandro Betocchi, Maria Angela Losi, Adele Ferro, Alberto Cuocolo, Raffaella Lombardi, Bruno Villari, Massimo Chiariello

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Abnormal blood-pressure response during exercise occurs in about one third of patients with hypertrophic cardiomyopathy (HCM), and it has been associated with a high risk of sudden cardiac death. We assessed the hemodynamics of exercise in HCM patients with abnormal blood-pressure response by using ambulatory radionuclide monitoring (VEST) of left-ventricular (LV) function, and exercise tolerance by oxygen consumption. Methods: Twenty-two HCM patients uderwent treadmill exercise during VEST monitoring. A cardiopulmonary exercise test was performed a few days after. The VEST data were averaged for 1 minute. Stroke volume, cardiac output, and systemic vascular resistance were expressed as percent of baseline. Exercise tolerance was assessed as maximal oxygen consumption. Results: In eight HCM patients (36%) with an abnormal blood-pressure response, end-systolic volume increased more (52% ± 21% vs 31% ± 28%, P = .012), and the ejection fraction (-31% ± 17% vs -14% ± 22%, P = .029) and stroke volume (-21% ± 21% vs 3% ± 28%, P = .026) fell more, than in patients with normal response. Cardiac output increased less in the former patients (49% ± 44% vs 94% ± 44%, P = .012). Systemic vascular resistance decreased similarly, irrespective of blood-pressure response (-28% ± 26% vs -34% ± 26%, P = N.S.). Percent of maximal predicted oxygen consumption was lower in HCM patients with an abnormal blood-pressure response (63% ± 11% vs 78% ± 15%, P = .025). Conclusions: In HCM patients, abnormal blood-pressure response was associated with exercise-induced LV systolic dysfunction and impairment in oxygen consumption. This may cause hemodynamic instability, associated with a high risk of sudden cardiac death.

Original languageEnglish
Pages (from-to)869-875
Number of pages7
JournalJournal of Nuclear Cardiology
Volume14
Issue number6
DOIs
Publication statusPublished - Nov 2007

Keywords

  • Cardiomyopathy
  • exercise
  • hemodynamics
  • hypertrophy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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