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. 2021 Mar 24;10(7):1347.
doi: 10.3390/jcm10071347.

Prognostic Value of Reduced Heart Rate Reserve during Exercise in Hypertrophic Cardiomyopathy

Quirino Ciampi  1   2 , Iacopo Olivotto  3 , Jesus Peteiro  4 , Maria Grazia D'Alfonso  3 , Fabio Mori  3 , Luigi Tassetti  3 , Alessandra Milazzo  3 , Lorenzo Monserrat  4 , Xusto Fernandez  4 , Attila Pálinkás  5 , Eszter Dalma Pálinkás  6 , Róbert Sepp  6 , Federica Re  7 , Lauro Cortigiani  8 , Milorad Tesic  9 , Ana Djordjevic-Dikic  9 , Branko Beleslin  9 , Mariangela Losi  10 , Grazia Canciello  10 , Sandro Betocchi  10 , Luis Rocha Lopes  11   12 , Ines Cruz  13 , Carlos Cotrim  14   15 , Marco A R Torres  16 , Clarissa C A Bellagamba  16 , Caroline M Van De Heyning  17 , Albert Varga  18 , Gergely Ágoston  18 , Bruno Villari  1 , Valentina Lorenzoni  19 , Clara Carpeggiani  2 , Eugenio Picano  2 , The Stress Echo Study Group On Behalf Of The Italian Society Of Echocardiography And Cardiovascular Imaging Siecvi
Affiliations

Prognostic Value of Reduced Heart Rate Reserve during Exercise in Hypertrophic Cardiomyopathy

Quirino Ciampi et al. J Clin Med. .

Abstract

Background: Sympathetic dysfunction can be evaluated by heart rate reserve (HRR) with exercise test.

Objectives: To determine the value of HRR in predicting outcome of patients with hypertrophic cardiomyopathy (HCM).

Methods: We enrolled 917 HCM patients (age = 49 ± 15 years, 516 men) assessed with exercise stress echocardiography (ESE) in 11 centres. ESE modality was semi-supine bicycle in 51 patients (6%), upright bicycle in 476 (52%), and treadmill in 390 (42%). During ESE, we assessed left ventricular outflow tract obstruction (LVOTO), stress-induced new regional wall motion abnormalities (RWMA), and HRR (peak/rest heart rate, HR). By selection, all patients completed the follow-up. Mortality was the predetermined outcome measure Results: During ESE, RWMA occurred in 22 patients (2.4%) and LVOTO (≥50 mmHg) in 281 (30.4%). HRR was 1.90 ± 0.40 (lowest quartile ≤ 1.61, highest quartile > 2.13). Higher resting heart rate (odds ratio 1.027, 95% CI: 1.018-1.036, p < 0.001), older age (odds ratio 1.021, 95% CI: 1.009-1.033, p < 0.001), lower exercise tolerance (mets, odds ratio 0.761, 95% CI: 0.708-0.817, p < 0.001) and resting LVOTO (odds ratio 1.504, 95% CI: 1.043-2.170, p = 0.029) predicted a reduced HRR. During a median follow-up of 89 months (interquartile range: 36-145 months), 90 all-cause deaths occurred. At multivariable analysis, lowest quartile HRR (Hazard ratio 2.354, 95% CI 1.116-4.968 p = 0.025) and RWMA (Hazard ratio 3.279, 95% CI 1.441-7.461 p = 0.004) independently predicted death, in addition to age (Hazard ratio 1.064, 95% CI 1.043-1.085 p < 0.001) and maximal wall thickness (Hazard ratio 1.081, 95% CI 1.037-1.128, p < 0.001).

Conclusions: A blunted HRR during ESE predicts survival independently of RWMA in HCM patients.

Keywords: autonomic dysfunction; hypertrophic cardiomyopathy; stress echocardiography.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The stress echo protocol. Rest (A,C) and peak stress (B,D). (A,B): Regional function is normal. EKG lead shows a blunted HRR response (rest = 54 bpm; peak exercise = 69 bpm; HRR = 1.27). (C,D): Continuous wave Doppler tracing of LVOTG (rest = 32 mmHg; peak exercise = 67 mmHg). During ESE, the patient shows, a significant LVOTG and an abnormally reduced HRR.
Figure 2
Figure 2
Survival curves based on HRR. Survival improves with higher values of (split in 4 quartiles).
See this image and copyright information in PMC

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