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Impaired Right Ventricular Mechanics at Rest and During Exercise Are Associated With Exercise Capacity in Patients With Hypertrophic Cardiomyopathy

BACKGROUND: Impaired right ventricular (RV) function indicates RV involvement in patients with hypertrophic cardiomyopathy (HCM). We aimed to assess RV function at rest and during exercise in HCM patients and to examine the association between impaired RV mechanics and exercise capacity. METHODS AND...

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Autores principales: Wu, Xiao‐Peng, Li, Yi‐Dan, Wang, Yi‐Dan, Zhang, Miao, Zhu, Wei‐Wei, Cai, Qi‐Zhe, Jiang, Wei, Sun, Lan‐Lan, Ding, Xue‐Yan, Ye, Xiao‐Guang, Qin, Yun‐Yun, Lu, Xiu‐Zhang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6474915/
https://www.ncbi.nlm.nih.gov/pubmed/30798647
http://dx.doi.org/10.1161/JAHA.118.011269
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author Wu, Xiao‐Peng
Li, Yi‐Dan
Wang, Yi‐Dan
Zhang, Miao
Zhu, Wei‐Wei
Cai, Qi‐Zhe
Jiang, Wei
Sun, Lan‐Lan
Ding, Xue‐Yan
Ye, Xiao‐Guang
Qin, Yun‐Yun
Lu, Xiu‐Zhang
author_facet Wu, Xiao‐Peng
Li, Yi‐Dan
Wang, Yi‐Dan
Zhang, Miao
Zhu, Wei‐Wei
Cai, Qi‐Zhe
Jiang, Wei
Sun, Lan‐Lan
Ding, Xue‐Yan
Ye, Xiao‐Guang
Qin, Yun‐Yun
Lu, Xiu‐Zhang
author_sort Wu, Xiao‐Peng
collection PubMed
description BACKGROUND: Impaired right ventricular (RV) function indicates RV involvement in patients with hypertrophic cardiomyopathy (HCM). We aimed to assess RV function at rest and during exercise in HCM patients and to examine the association between impaired RV mechanics and exercise capacity. METHODS AND RESULTS: A total of 76 HCM patients (48 without and 28 with RV hypertrophy) and 30 age‐ and sex‐matched controls were prospectively recruited. RV function was evaluated at rest and during semisupine bicycle exercise by conventional echocardiography and 2‐dimensional speckle‐tracking imaging. Exercise capacity was measured by metabolic equivalents. RV functional reserve was calculated as the difference of functional parameters between peak exercise and rest. Compared with controls, HCM patients had significantly higher RV free wall thickness, lower RV global longitudinal strain and RV free wall longitudinal strain at rest and during exercise, and reduced RV systolic functional reserve. Compared with those with HCM without RV hypertrophy, patients with HCM with RV hypertrophy had lower metabolic equivalents. Among HCM patients, an effective correlation was seen between exercise capacity and peak exercise RV global longitudinal strain and peak exercise RV free wall longitudinal strain. A binary logistic regression model revealed several independent predictors of exercise intolerance in HCM patients, but receiver operating characteristic curve analysis indicated exercise RV global longitudinal strain had the highest area under the curve for the prediction of exercise intolerance in HCM patients. CONCLUSIONS: HCM patients have RV dysfunction and reduced contractile reserve. Exercise RV global longitudinal strain correlates with exercise capacity and can independently predict exercise intolerance. In addition, patients with HCM with RV hypertrophy exhibit more reduced exercise capacity, suggesting more severe disease and poorer prognosis.
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spelling pubmed-64749152019-04-24 Impaired Right Ventricular Mechanics at Rest and During Exercise Are Associated With Exercise Capacity in Patients With Hypertrophic Cardiomyopathy Wu, Xiao‐Peng Li, Yi‐Dan Wang, Yi‐Dan Zhang, Miao Zhu, Wei‐Wei Cai, Qi‐Zhe Jiang, Wei Sun, Lan‐Lan Ding, Xue‐Yan Ye, Xiao‐Guang Qin, Yun‐Yun Lu, Xiu‐Zhang J Am Heart Assoc Original Research BACKGROUND: Impaired right ventricular (RV) function indicates RV involvement in patients with hypertrophic cardiomyopathy (HCM). We aimed to assess RV function at rest and during exercise in HCM patients and to examine the association between impaired RV mechanics and exercise capacity. METHODS AND RESULTS: A total of 76 HCM patients (48 without and 28 with RV hypertrophy) and 30 age‐ and sex‐matched controls were prospectively recruited. RV function was evaluated at rest and during semisupine bicycle exercise by conventional echocardiography and 2‐dimensional speckle‐tracking imaging. Exercise capacity was measured by metabolic equivalents. RV functional reserve was calculated as the difference of functional parameters between peak exercise and rest. Compared with controls, HCM patients had significantly higher RV free wall thickness, lower RV global longitudinal strain and RV free wall longitudinal strain at rest and during exercise, and reduced RV systolic functional reserve. Compared with those with HCM without RV hypertrophy, patients with HCM with RV hypertrophy had lower metabolic equivalents. Among HCM patients, an effective correlation was seen between exercise capacity and peak exercise RV global longitudinal strain and peak exercise RV free wall longitudinal strain. A binary logistic regression model revealed several independent predictors of exercise intolerance in HCM patients, but receiver operating characteristic curve analysis indicated exercise RV global longitudinal strain had the highest area under the curve for the prediction of exercise intolerance in HCM patients. CONCLUSIONS: HCM patients have RV dysfunction and reduced contractile reserve. Exercise RV global longitudinal strain correlates with exercise capacity and can independently predict exercise intolerance. In addition, patients with HCM with RV hypertrophy exhibit more reduced exercise capacity, suggesting more severe disease and poorer prognosis. John Wiley and Sons Inc. 2019-02-23 /pmc/articles/PMC6474915/ /pubmed/30798647 http://dx.doi.org/10.1161/JAHA.118.011269 Text en © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Research
Wu, Xiao‐Peng
Li, Yi‐Dan
Wang, Yi‐Dan
Zhang, Miao
Zhu, Wei‐Wei
Cai, Qi‐Zhe
Jiang, Wei
Sun, Lan‐Lan
Ding, Xue‐Yan
Ye, Xiao‐Guang
Qin, Yun‐Yun
Lu, Xiu‐Zhang
Impaired Right Ventricular Mechanics at Rest and During Exercise Are Associated With Exercise Capacity in Patients With Hypertrophic Cardiomyopathy
title Impaired Right Ventricular Mechanics at Rest and During Exercise Are Associated With Exercise Capacity in Patients With Hypertrophic Cardiomyopathy
title_full Impaired Right Ventricular Mechanics at Rest and During Exercise Are Associated With Exercise Capacity in Patients With Hypertrophic Cardiomyopathy
title_fullStr Impaired Right Ventricular Mechanics at Rest and During Exercise Are Associated With Exercise Capacity in Patients With Hypertrophic Cardiomyopathy
title_full_unstemmed Impaired Right Ventricular Mechanics at Rest and During Exercise Are Associated With Exercise Capacity in Patients With Hypertrophic Cardiomyopathy
title_short Impaired Right Ventricular Mechanics at Rest and During Exercise Are Associated With Exercise Capacity in Patients With Hypertrophic Cardiomyopathy
title_sort impaired right ventricular mechanics at rest and during exercise are associated with exercise capacity in patients with hypertrophic cardiomyopathy
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6474915/
https://www.ncbi.nlm.nih.gov/pubmed/30798647
http://dx.doi.org/10.1161/JAHA.118.011269
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