[The evolution of the arterial pressure during a stress test in patients with hypertrophic myocardiopathy].
OBJECTIVE
To study the exercise blood pressure response in patients with hypertrophic cardiomyopathy (HC) and its relationship with sudden death.


METHODS
Retrospective study.


METHODS
We studied 51 patients (P) with HC: 18 women and 33 men. Their average age was 45 +/- 14 years, with a mean follow-up of 55 +/- 37 months.


METHODS
Every patient had been subjected to a treadmill stress-test, a 24-hour Holter monitoring and an echocardiographic examination. Particular emphasis was given to blood pressure increments (BPI) during stress-test, the existence of premature ventricular contractions with a frequency of 10 or more per hour (PVC > or = 10), the occurrence of couplets (C) and/or non-sustained ventricular tachycardia (NSVT) on a 24-hour Holter. Finally, the finding of systolic anterior motion (SAM) of the mitral valve, in the routine echocardiogram, was valued.


RESULTS
Four patterns of BPI were identified: "1": normal evolution (27 P); "2": plateau type increment (16 P); "3": fall in blood pressure during exercise (6 P); "4": abnormal BPI during recovery (2 P). Two groups were considered: group N-normal BPI, group A-patients with abnormal blood pressure responses. There were no significant differences among therapeutic agents, between the two groups, when the stress-test was performed. SAM was found in 21 P. Only 8 P registered ventricular arrhythmias, half of them with NSVT. No statistical relations were found between BPI and P age, the presence of SAM, PVC > or = 10, C, or NSVT. We found 78% of P in group N in NYHA class I. In contrast, in group A only 46% were in class I (p = 0.04). Only one death, of non cardiac cause, occurred (group A).


CONCLUSIONS
There is a large number of patients with HC and abnormal BPI. This is, seemingly, not influenced either by a dynamic left ventricular gradient or by ventricular ectopic beat occurrence. However, a relation appears to exist between the abnormal response and functional class, not explained by the usual (noninvasive) clinical tests.
Bronze
L
L
Serviço de Cardiologia, Hospital de Santa Cruz.
Santos
L
L
Ventosa
A
A
Ferreira
J
J
Palos
J L
JL
Mendes
M
M
Bonhorst
D
D
Seabra-Gomes
R
R
D000328:Adult; D001794:Blood Pressure; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis / Q000503:physiopathology*; D016757:Death, Sudden, Cardiac / Q000209:etiology; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D005080:Exercise Test / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016277:Ventricular Function, Left
Evolução da pressão arterial durante a prova de esforço, em doentes com miocardiopatia hipertrófica.