title: Prognostic role of stress echocardiography in hypertrophic cardiomyopathy: The International Stress Echo Registry.
abstract: BACKGROUND
  Stress echo (SE) may have a role in the outcome in patients with hypertrophic cardiomyopathy (HCM).
  
  
  OBJECTIVE
  The aim was to assess the prognostic value of SE in a retrospective multicenter study in HCM.
  
  
  METHODS
  We enrolled 706 HCM patients. The employed stress was exercise (n=608) and/or vasodilator (n=146, dipyridamole in 98 and adenosine in 48). We defined SE positivity according to clinical/hemodynamic criteria including: symptoms (all stress modalities), exercise-induced hypotension (failure to increase or fall >20mmHg, exercise) and exercise-induced left ventricular outflow tract obstruction (left ventricular outflow tract obstruction >50mmHg); and ischemic criteria, such as new wall motion abnormalities (new wall motion abnormality) and/or reduction of coronary flow reserve velocity (CFVR≤2.0) on left anterior descending coronary artery with vasodilator stress assessed in 116 patients. All patients completed the clinical follow-up.
  
  
  RESULTS
  Positive SE showed more frequently CFVR reduction, exercise-induced hypotension, left ventricular outflow tract obstruction, and symptoms (38, 23, 20 and 15% respectively), but new wall motion abnormality only in 6%. During a median follow-up of 49months 180 events were observed, including 40 deaths. Clinical/hemodynamic criteria did not predict outcome (X2 0.599, p=0.598), whereas ischemia-related SE criteria (X2: 111.120, p<0.0001) was significantly related to outcome. Similarly, mortality was predicted with SE ischemic-criteria (X2 16.645, p<0.0001).
  
  
  CONCLUSIONS
  SE has an important prognostic significance in HCM patients, with ischemia-related end-points showing greater predictive accuracy than hemodynamic endpoints. New wall motion abnormalities and impairment of CFVR should be specifically included in SE protocols for HCM.
authors.affiliation: Fatebenefratelli Hospital, Benevento, Italy; Institute of Clinical Physiology, CNR, Pisa, Italy. Electronic address: qciampi@gmail.com.
authors.forename: Quirino
authors.initials: Q
authors.lastname: Ciampi
authors.affiliation: Careggi University Hospital, Florence, Italy.
authors.forename: Iacopo
authors.initials: I
authors.lastname: Olivotto
authors.affiliation: Careggi University Hospital, Florence, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Gardini
authors.affiliation: Careggi University Hospital, Florence, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Mori
authors.affiliation: CHUAC, University of A Coruña, Spain.
authors.forename: Jesus
authors.initials: J
authors.lastname: Peteiro
authors.affiliation: CHUAC, University of A Coruña, Spain.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Monserrat
authors.affiliation: CHUAC, University of A Coruña, Spain.
authors.forename: Xusto
authors.initials: X
authors.lastname: Fernandez
authors.affiliation: Civil Hospital, Lucca, Italy.
authors.forename: Lauro
authors.initials: L
authors.lastname: Cortigiani
authors.affiliation: Dell'Angelo Hospital, Mestre, Venice, Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Rigo
authors.affiliation: Hospital Garcia de Orta, Almada, Portugal; Cardiovascular Centre, University of Lisbon, Lisbon, Portugal.
authors.forename: Luis Rocha
authors.initials: LR
authors.lastname: Lopes
authors.affiliation: Hospital Garcia de Orta, Almada, Portugal.
authors.forename: Ines
authors.initials: I
authors.lastname: Cruz
authors.affiliation: Cardiovascular Centre, University of Lisbon, Lisbon, Portugal.
authors.forename: Carlos
authors.initials: C
authors.lastname: Cotrim
authors.affiliation: Federico II University, Naples, Italy.
authors.forename: Mariangela
authors.initials: M
authors.lastname: Losi
authors.affiliation: Federico II University, Naples, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Betocchi
authors.affiliation: Cardiology Clinic, Clinical Center of Serbia Medical School, University of Belgrade, Serbia.
authors.forename: Branko
authors.initials: B
authors.lastname: Beleslin
authors.affiliation: Cardiology Clinic, Clinical Center of Serbia Medical School, University of Belgrade, Serbia.
authors.forename: Milorad
authors.initials: M
authors.lastname: Tesic
authors.affiliation: Cardiology Clinic, Clinical Center of Serbia Medical School, University of Belgrade, Serbia.
authors.forename: Ana Djordjevic
authors.initials: AD
authors.lastname: Dikic
authors.affiliation: Fondazione Don Gnocchi, Parma, Italy.
authors.forename: Ettore
authors.initials: E
authors.lastname: Lazzeroni
authors.affiliation: Fondazione Don Gnocchi, Parma, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Lazzeroni
authors.affiliation: Institute of Clinical Physiology, CNR, Pisa, Italy.
authors.forename: Rosa
authors.initials: R
authors.lastname: Sicari
authors.affiliation: Institute of Clinical Physiology, CNR, Pisa, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Picano
mesh_terms: D000328:Adult; D000368:Aged; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000503:physiopathology; D025401:Echocardiography, Stress / Q000379:methods*; D005080:Exercise Test / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014665:Vasodilator Agents
keywords: Hypertrophic cardiomyopathy; Stress echocardiography