Ventilatory Efficiency and Resting Hemodynamics in Hypertrophic Cardiomyopathy

• Autores: Ross Arena, David S. Owens, Josefino Arevalo, Kevin Smith, Saidi A. Mohiddin, Dorothea Mcareavey, Karen L. Ulisney, Dorothy J. Tripodi, Lameh Fananapazir, Jonathan f. Plehn
• Localización: Medicine & Science in Sports & exercise: Official Journal of the American College of Sports Medicine, ISSN 0195-9131, Vol. 40, Nº. 5, 2008, págs. 799-805
• Idioma: inglés
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• Resumen

  • Purpose: In patients with systolic heart failure, the ability of cardiopulmonary exercise testing (CPX) variables to reflect pathophysiology is well established. The relationship between CPX and pathophysiology has, however, not been thoroughly investigated in patients with nonobstructive hypertrophic cardiomyopathy (NHCM). The objective of this study was to assess the ability of CPX variables to reflect resting hemodynamics in patients with nonobstructive hypertrophic cardiomyopathy NHCM.

    Methods: We performed CPX and right heart catheterization on 83 subjects with NHCM (51 male/32 female, mean age = 38 +/- 10 yr, NYHA I-III mean = 1.7). Peak oxygen consumption (V[spacing dot above]O2) and minute ventilation/carbon dioxide ratio (V[spacing dot above]E/V[spacing dot above]CO2) at peak exercise were compared to resting hemodynamics including pulmonary artery systolic, diastolic and mean pressures (PASP, PADP and MPAP), and pulmonary capillary wedge pressure (PCWP).

    Results: Elevations in PCWP (>= 15 mm Hg), PASP (>=30 and >= 40 mm Hg), PADP (> 15 mm Hg) and MPAP (>= 20 mm Hg) were detected in 22, 33, 10, and 23% of subjects, respectively. Peak V[spacing dot above]E/V[spacing dot above]CO2 (positive correlation) and peak V[spacing dot above]O2 (negative correlation) correlated modestly with all pressure measurements (r = 0.33-0.51, P < 0.01 for all measurements). By receiver operating curve analysis, a V[spacing dot above]E/V[spacing dot above]CO2 >35.5 exhibited the best diagnostic accuracy with a curve areas of 0.81 for PAP >= 30 mm Hg (sensitivity/specificity = 86%/67%), 0.87 for PAP >= 40 mm Hg (77%/100%), 0.86 for MPAP > 20 mm Hg (83%/79%), and 0.84 for PCWP >= 15 mm Hg (80%/76%).

    Conclusions: CPX can accurately identify abnormal resting hemodynamics in patients with NHCM. Further testing of this modality in other forms of diastolic dysfunction may be warranted.