Abstract
Background: A blunted heart rate (HR) response is associated with an impaired peak oxygen uptake (pVO2), a powerful outcome predictor in hypertrophic cardiomyopathy (HCM). The present multicenter study sought to determine the prognostic role for exercise-induced HR response in HCM. Methods: A total of 681 consecutive HCM outpatients on optimized treatment were recruited. The heart failure (HF) end-point was death due to HF, cardiac transplantation, NYHA III-IV class progression, HF worsening leading to hospitalization and severe functional deterioration leading to septal reduction. The sudden cardiac death (SCD) end-point included SCD, aborted SCD and appropriate implantable cardioverter defibrillator discharges. Results: During a median follow-up of 4.2 years (25–75th centile: 3.9–5.2), 81 patients reached the HF and 23 the SCD end-point. Covariates with independent effects on the HF end-point were left atrial diameter, left ventricular ejection fraction, maximal left ventricular outflow tract gradient and exercise cardiac power (ECP = pVO2∗systolic blood pressure) (C-Index = 0.807) whereas the HCM Risk-SCD score and the ECP remained associated with the SCD end-point (C-Index = 0.674). When the VO2-derived variables were not pursued, peak HR (pHR) re-entered in the multivariate HF model (C-Index = 0.777) and, marginally, in the SCD model (C-index = 0.656). A pHR = 70% of the maximum predicted resulted as the best cut-off value in predicting the HF-related events. Conclusions: The cardiopulmonary exercise test is pivotal in the HCM management, however the pHR remains a meaningful alternative parameter. A pHR < 70% identified a HCM population at high risk of HF-related events, thus calling for a reappraisal of the chronotropic incompetence threshold in HCM.
| Original language | English |
|---|---|
| Pages (from-to) | 125-131 |
| Number of pages | 7 |
| Journal | International Journal of Cardiology |
| Volume | 271 |
| DOIs | |
| Publication status | Published - Nov 15 2018 |
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Keywords
- Chronotropic incompetence
- Heart rate
- Hypertrophic cardiomyopathy
- Prognosis
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
Clinical and prognostic impact of chronotropic incompetence in patients with hypertrophic cardiomyopathy. / Magri, Damiano; Agostoni, Piergiuseppe; Sinagra, Gianfranco; Re, Federica; Correale, Michele; Limongelli, Giuseppe; Zachara, Elisabetta; Mastromarino, Vittoria; Santolamazza, Caterina; Casenghi, Matteo; Pacileo, Giuseppe; Valente, Fabio; Morosin, Marco; Musumeci, Beatrice; Pagannone, Erika; Maruotti, Antonello; Uguccioni, Massimo; Volpe, Massimo; Autore, Camillo.
In: International Journal of Cardiology, Vol. 271, 15.11.2018, p. 125-131.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Clinical and prognostic impact of chronotropic incompetence in patients with hypertrophic cardiomyopathy
AU - Magri, Damiano
AU - Agostoni, Piergiuseppe
AU - Sinagra, Gianfranco
AU - Re, Federica
AU - Correale, Michele
AU - Limongelli, Giuseppe
AU - Zachara, Elisabetta
AU - Mastromarino, Vittoria
AU - Santolamazza, Caterina
AU - Casenghi, Matteo
AU - Pacileo, Giuseppe
AU - Valente, Fabio
AU - Morosin, Marco
AU - Musumeci, Beatrice
AU - Pagannone, Erika
AU - Maruotti, Antonello
AU - Uguccioni, Massimo
AU - Volpe, Massimo
AU - Autore, Camillo
PY - 2018/11/15
Y1 - 2018/11/15
N2 - Background: A blunted heart rate (HR) response is associated with an impaired peak oxygen uptake (pVO2), a powerful outcome predictor in hypertrophic cardiomyopathy (HCM). The present multicenter study sought to determine the prognostic role for exercise-induced HR response in HCM. Methods: A total of 681 consecutive HCM outpatients on optimized treatment were recruited. The heart failure (HF) end-point was death due to HF, cardiac transplantation, NYHA III-IV class progression, HF worsening leading to hospitalization and severe functional deterioration leading to septal reduction. The sudden cardiac death (SCD) end-point included SCD, aborted SCD and appropriate implantable cardioverter defibrillator discharges. Results: During a median follow-up of 4.2 years (25–75th centile: 3.9–5.2), 81 patients reached the HF and 23 the SCD end-point. Covariates with independent effects on the HF end-point were left atrial diameter, left ventricular ejection fraction, maximal left ventricular outflow tract gradient and exercise cardiac power (ECP = pVO2∗systolic blood pressure) (C-Index = 0.807) whereas the HCM Risk-SCD score and the ECP remained associated with the SCD end-point (C-Index = 0.674). When the VO2-derived variables were not pursued, peak HR (pHR) re-entered in the multivariate HF model (C-Index = 0.777) and, marginally, in the SCD model (C-index = 0.656). A pHR = 70% of the maximum predicted resulted as the best cut-off value in predicting the HF-related events. Conclusions: The cardiopulmonary exercise test is pivotal in the HCM management, however the pHR remains a meaningful alternative parameter. A pHR < 70% identified a HCM population at high risk of HF-related events, thus calling for a reappraisal of the chronotropic incompetence threshold in HCM.
AB - Background: A blunted heart rate (HR) response is associated with an impaired peak oxygen uptake (pVO2), a powerful outcome predictor in hypertrophic cardiomyopathy (HCM). The present multicenter study sought to determine the prognostic role for exercise-induced HR response in HCM. Methods: A total of 681 consecutive HCM outpatients on optimized treatment were recruited. The heart failure (HF) end-point was death due to HF, cardiac transplantation, NYHA III-IV class progression, HF worsening leading to hospitalization and severe functional deterioration leading to septal reduction. The sudden cardiac death (SCD) end-point included SCD, aborted SCD and appropriate implantable cardioverter defibrillator discharges. Results: During a median follow-up of 4.2 years (25–75th centile: 3.9–5.2), 81 patients reached the HF and 23 the SCD end-point. Covariates with independent effects on the HF end-point were left atrial diameter, left ventricular ejection fraction, maximal left ventricular outflow tract gradient and exercise cardiac power (ECP = pVO2∗systolic blood pressure) (C-Index = 0.807) whereas the HCM Risk-SCD score and the ECP remained associated with the SCD end-point (C-Index = 0.674). When the VO2-derived variables were not pursued, peak HR (pHR) re-entered in the multivariate HF model (C-Index = 0.777) and, marginally, in the SCD model (C-index = 0.656). A pHR = 70% of the maximum predicted resulted as the best cut-off value in predicting the HF-related events. Conclusions: The cardiopulmonary exercise test is pivotal in the HCM management, however the pHR remains a meaningful alternative parameter. A pHR < 70% identified a HCM population at high risk of HF-related events, thus calling for a reappraisal of the chronotropic incompetence threshold in HCM.
KW - Chronotropic incompetence
KW - Heart rate
KW - Hypertrophic cardiomyopathy
KW - Prognosis
UR - http://www.scopus.com/inward/record.url?scp=85045855063&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85045855063&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2018.04.019
DO - 10.1016/j.ijcard.2018.04.019
M3 - Article
C2 - 30087038
AN - SCOPUS:85045855063
VL - 271
SP - 125
EP - 131
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
ER -