title: Relationship between baseline resting diastolic function and exercise capacity in patients with hypertrophic cardiomyopathy undergoing treadmill stress echocardiography: a cohort study.
abstract: OBJECTIVE
  Diastolic dysfunction (DD) is often incriminated in the symptomatology of patients with hypertrophic cardiomyopathy (HCM), but with limited supporting data. This study sought to assess the relationship between baseline diastolic function and exercise capacity in patients with HCM.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Tertiary referral centre from Cleveland, Ohio, USA.
  
  
  METHODS
  695 consecutive patients with a diagnosis of HCM who underwent exercise stress echocardiography between 1996 and 2011.
  
  
  METHODS
  Diastolic function was reassessed from the resting echocardiograms by two blinded board-certified cardiologists. Maximal metabolic equivalents (MET) were extracted from the records. Multivariate regression analysis was performed to determine independent predictors of METs achieved.
  
  
  RESULTS
  Of 695 patients, 130 were excluded because of inability to assess diastolic function. There was no significant difference in maximal METs achieved between those excluded and included in the analysis (p=0.80). There were 495 remaining patients with a mean age (SD) of 50 (15) years, and 32% women among whom 102 (21%) had normal diastolic function, 243 (49%) stage 1 DD; 131 (26%) stage 2 DD and 19 (4%) stage 3 DD. Patients with advanced DD had lower maximal METs achieved compared with those with normal diastolic function (OR 3.18(1.96 to 5.14) for stage 1 versus normal, and 3.21(1.89 to 5.43) for stage ≥2 versus normal, p<0.0001 for both). After adjustment for demographics, comorbidities, echocardiographic parameters and haemodynamics, baseline DD was not an independent predictor of maximal METs achieved.
  
  
  CONCLUSIONS
  Although baseline DD is common in patients with HCM, it does not predict maximal METs achieved beyond traditional risk factors.
authors.affiliation: Robert and Suzanne Tomsich Department of Cardiovascular Medicine,  Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio,  USA.
authors.forename: Wael A
authors.initials: WA
authors.lastname: Aljaroudi
authors.forename: Milind Y
authors.initials: MY
authors.lastname: Desai
authors.forename: M Chadi
authors.initials: MC
authors.lastname: Alraies
authors.forename: Maran
authors.initials: M
authors.lastname: Thamilarasan
authors.forename: Venu
authors.initials: V
authors.lastname: Menon
authors.forename: L Leonardo
authors.initials: LL
authors.lastname: Rodriguez
authors.forename: Nicholas
authors.initials: N
authors.lastname: Smedira
authors.forename: Richard A
authors.initials: RA
authors.lastname: Grimm
authors.forename: Harry M
authors.initials: HM
authors.lastname: Lever
authors.forename: Wael A
authors.initials: WA
authors.lastname: Jaber