title: Comparison of resting and exercise echocardiographic parameters as indicators of outcomes in hypertrophic cardiomyopathy.
abstract: BACKGROUND
  Both resting echocardiography and exercise echocardiography produce variables predictive of outcomes in patients with hypertrophic cardiomyopathy (HCM). The aim of the present study was to compare the respective value of resting and exercise echocardiographic parameters as indicators of clinical outcomes in patients with HCM.
  
  
  METHODS
  Resting and exercise echocardiography was performed prospectively in patients with HCM evaluated at the HCM Competence Center of Bordeaux and followed up every 6 months. A composite cardiac event was defined.
  
  
  RESULTS
  One hundred fifteen patients (mean age, 51.9 ± 15.2 years; 66% men) were evaluated by echocardiography and followed for a mean period of 19 ± 11 months. Eighteen patients (16%) reached the composite end point, including 10 progressions to New York Heart Association functional class III or IV. On rest echocardiography, in patients with cardiac events during follow-up, left atrial volume index was significantly more increased, as were lateral E/E' ratio and left ventricular outflow tract (LVOT) gradient, whereas mean global longitudinal strain (GLS) expressed in magnitude (14.0 ± 2.6% vs 17.0 ± 3.6%, P < .001) and peak velocities at the lateral annulus by Doppler tissue imaging were significantly reduced compared with patients without events. At peak exercise, patients who developed cardiac events were characterized by lower ejection fractions and greater LVOT gradients (76 ± 55 mm Hg vs 40 ± 40 mm Hg, P < .002). A Cox backward-entry selection model revealed that GLS ≤ 15% at rest and LVOT gradient ≥ 50 mm Hg at peak exercise were independently associated with an increased risk for poor outcomes in patients with HCM (hazard ratios, 3.8 [P = .017] and 3.3 [P = .028], respectively). On Kaplan-Meier survival analyses, peak exercise LVOT gradient evaluation showed additive value to predict outcomes, particularly in patients with rest GLS > 15% (log-rank P = .001) and despite a resting LVOT gradient ≥ 30 mm Hg (log-rank P = .001).
  
  
  CONCLUSIONS
  This study supports the value of resting GLS and of peak LVOT gradient, measured during exercise echocardiography, in identifying patients with HCM at increased risk for adverse events during follow-up.
authors.affiliation: Cardiologic Hospital CHU Bordeaux - CIC0005, Bordeaux University, Pessac, France. Electronic address: patricia.reant@chu-bordeaux.fr.
authors.forename: Patricia
authors.initials: P
authors.lastname: Reant
authors.affiliation: Cardiologic Hospital CHU Bordeaux - CIC0005, Bordeaux University, Pessac, France.
authors.forename: Amelie
authors.initials: A
authors.lastname: Reynaud
authors.affiliation: Cardiologic Hospital CHU Bordeaux - CIC0005, Bordeaux University, Pessac, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Pillois
authors.affiliation: Cardiologic Hospital CHU Bordeaux - CIC0005, Bordeaux University, Pessac, France.
authors.forename: Marina
authors.initials: M
authors.lastname: Dijos
authors.affiliation: Cardiologic Hospital CHU Bordeaux - CIC0005, Bordeaux University, Pessac, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Arsac
authors.affiliation: Cardiologic Hospital CHU Bordeaux - CIC0005, Bordeaux University, Pessac, France.
authors.forename: Cecile
authors.initials: C
authors.lastname: Touche
authors.affiliation: Cardiologic Hospital CHU Bordeaux - CIC0005, Bordeaux University, Pessac, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Landelle
authors.affiliation: Cardiologic Hospital CHU Bordeaux - CIC0005, Bordeaux University, Pessac, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Rooryck
authors.affiliation: Cardiologic Hospital CHU Bordeaux - CIC0005, Bordeaux University, Pessac, France.
authors.forename: Raymond
authors.initials: R
authors.lastname: Roudaut
authors.affiliation: Cardiologic Hospital CHU Bordeaux - CIC0005, Bordeaux University, Pessac, France.
authors.forename: Stephane
authors.initials: S
authors.lastname: Lafitte
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D015331:Cohort Studies; D018450:Disease Progression; D015150:Echocardiography, Doppler / Q000379:methods*; D025401:Echocardiography, Stress / Q000379:methods*; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors
keywords: Echocardiography; Exercise echocardiography; Hypertrophic cardiomyopathy; Myocardial strain; Prognosis