Prognostic role of stress echocardiography in hypertrophic cardiomyopathy: The International Stress Echo Registry. (15th September 2016)

• Record Type: Journal Article
• Authors: Ciampi, Quirino; Olivotto, Iacopo; Gardini, Chiara; Mori, Fabio; Peteiro, Jesus; Monserrat, Lorenzo; Fernandez, Xusto; Cortigiani, Lauro; Rigo, Fausto; Lopes, Luis Rocha; Cruz, Ines; Cotrim, Carlos; Losi, Mariangela; Betocchi, Sandro; Beleslin, Branko; Tesic, Milorad; Dikic, Ana Djordjevic; Lazzeroni, Ettore; Lazzeroni, Davide; Sicari, Rosa; Picano, Eugenio
• Is Part Of: International journal of cardiology. Volume 219(2016)
• Page Start: 331
• Page End: 338
• Publication Date: 2016-09-15
• Subjects: CFVR coronary flow velocity reserve -- HCM hypertrophic cardiomyopathy -- SE stress echocardiography; Hypertrophic cardiomyopathy -- Stress echocardiography; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.06.044
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Stress echo (SE) may have a role in the outcome in patients with hypertrophic cardiomyopathy (HCM). Objectives: 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 > 20 mm Hg, exercise) and exercise-induced left ventricular outflow tract obstruction (left ventricular outflow tract obstruction > 50 mm Hg); 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 49 months 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.