Failure to raise blood pressure during exercise is a poor prognostic sign in patients with hypertrophic non-obstructive cardiomyopathy.
Sudden cardiac death is a well-documented complication of hypertrophic cardiomyopathy and additionally, failure to raise blood pressure (BP) during exercise has been associated with a poor outcome. The present study group comprised 58 patients with hypertrophic non-obstructive cardiomyopathy (HNCM) who were receiving beta-blocker therapy. All patients underwent submaximal exercise radionuclide ventriculography (RNVG) to evaluate left ventricular (LV) function at both rest and peak exercise. Patients were divided into 2 groups based on the increase in systolic BP during exercise (ie, group A <30% or group N >/=30% of resting systolic BP) and were involved in long-term follow-up (10.4+/-4.0 years). Group A comprised 29% of the subjects. Age and workload at peak exercise were similar in the 2 groups. LV end-diastolic dimension was smaller and the interventricular septum was thicker in group A. LV ejection fraction on RNVG was similar in the 2 groups at rest and at peak exercise. During the follow-up period, more patients in group A than group N suffered syncopal attack (29% vs 5%, p<0.05) and cardiac sudden death (24% vs 2%, p<0.05). Patients with HNCM whose BP fails to rise during exercise have a poor prognosis.
Isobe
Naoki
N
Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan. isobe.n@cvc.pref.gunma.jp
Toyama
Takuji
T
Taniguchi
Koichi
K
Oshima
Shigeru
S
Kubota
Sachio
S
Suzuki
Tadashi
T
Nagaoka
Hideki
H
Adachi
Hitoshi
H
Naito
Shigeto
S
Hoshizaki
Hiroshi
H
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D001794:Blood Pressure; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology*; D002423:Cause of Death; D016757:Death, Sudden, Cardiac / Q000209:etiology; D015444:Exercise; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015635:Radionuclide Ventriculography; D015996:Survival Rate; D013575:Syncope / Q000209:etiology; D016277:Ventricular Function, Left
D000319:Adrenergic beta-Antagonists