0372: Impact of exercise mitral regurgitation on hypertrophic cardiomyopathy outcomes

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• 作者：Damien Feneon⁽¹⁾ ; Erwan Donal ; ⁽¹⁾ ; ^{erwan.donal@chu-rennes.fr" class="auth_mail" title="E-mail the corresponding author} ; Frederic Schnell⁽²⁾ ; Jean-Claude Daubert⁽²⁾ ; Elena Galli⁽²⁾ ; Philippe Mabo⁽²⁾
• 刊名：Archives of Cardiovascular Diseases Supplements
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：8
• 期：1
• 页码：32
• 全文大小：48 K

文摘

Rest echocardiography plays a role in the diagnosis and risk stratification of hypertrophic cardiomyopathy (HCM). Indeed, left atrial enlargement, severe left ventricle (LV) hypertrophy and rest LV outflow tract (LVOT) gradients ≥50mmHg are sudden cardiac death risk factors as highlighted in recent guidelines. Conversely, exercise echocardiography findings play only a limited role in prognosis evaluations. Therefore, we sought to determine whether exercise induced changes in myocardial and valvular functions could improve HCM risk stratification.

Methods and results

Consecutive HCM patients with a preserved LV ejection fraction underwent standardized exercise echocardiography (including the assessment of myocardial function, dynamic left intra-ventricular gradient and valvular regurgitations) at baseline and were clinically followed for a median of 29.3 months. The primary endpoint was a composite criterion that included death from any cause, cardiorespiratory arrest, and hospitalization for a cardiovascular event. A total of 126 patients were included. Eighteen patients reached the primary endpoint. According to univariate Cox regression analysis, exercise LVOT gradient ≥50mmHg (HR=3.31, p=0.01) and significant (≥2/4) exercise mitral regurgitation (HR=3.64, p<0.01) were associated with the primary endpoint. Patients with significant MR had significantly higher rest and exercise LVOT gradients (p=0.001 and p=0.001) and larger left atria (p<0.001).

Conclusion

Significant exercise mitral regurgitation appears to significantly impact the prognoses of HCM patients, and it is also associated with higher LVOT rest and exercise gradients.