Left ventricular filling pressure assessed by exercise TDI was correlated with early HFNEF in patients with non-obstructive hypertrophic cardiomyopathy.

Guodong Ma,Hui Chen,Weihong Li,Aidong Shen,Wei Gao,Zhaoping Li,Jieli Feng,Yongzhen Zhang,Hongyan Wang,Wenying Ma,Xinheng Feng,Baoxia Chen,Ming Xu

doi:10.1186/1471-2261-14-194

Abstract

BackgroundHypertrophic cardiomyopathy (HCM) patients are more susceptible to suffer from heart failure with normal ejection fraction (HFNEF). Therefore, it is critical to evaluate the relationship between left ventricular filling pressure (LVFP) and HFNEF, even if a large proportion of HCM patients have normal LVFP at rest. The objective was to assess the correlation between exercise tissue Doppler imaging (TDI) and early HFNEF in HCM patients by treadmill exercise echocardiography combined with cardiopulmonary exercise test (CPET).MethodTwenty-seven non-obstructive HCM patients and 31 age- and gender-matched healthy volunteers were enrolled in this study. All subjects underwent treadmill exercise echocardiography combined with CPET. N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were analyzed before and after exercise.ResultFive HCM patients had normal LVFP at rest and increased after exercise. For this subgroup, the relationship between minute ventilation and carbon dioxide production (VE/VCO2 slope) and NT-proBNP levels were higher compared with controls and the subgroup with normal resting and stress LVFP, but was similar to the subgroup with elevated LVFP both at rest and after exercise.ConclusionElevated LVFP after exercise suggested the occurrence of early HFNEF in patients with non-obstructive HCM.

Highlights

Hypertrophic cardiomyopathy (HCM) patients are more susceptible to suffer from heart failure with normal ejection fraction (HFNEF)
The aim of this study was to assess the relationship between exercise tissue Doppler imaging (TDI) and early HFNEF changes in HCM patients using treadmill exercise echocardiography combined with cardiopulmonary exercise test (CPET)
There were no differences in age, gender, body mass index (BMI), and comorbidities

Summary

Introduction

Hypertrophic cardiomyopathy (HCM) patients are more susceptible to suffer from heart failure with normal ejection fraction (HFNEF). The LVFP of HFNEF patients will increase sharply because of the increase of the left ventricular preload [7,8,9,10], while this increase is not observed in adults with normal left ventricular diastolic function [11]. The N-terminal pro-brain natriuretic peptide (NT-proBNP) is secreted by the ventricles of the heart in response to excessive stretching of the cardiomyocytes. It is considered a marker of heart damage, and can be used both for screening and prognosis of heart failure [19,20]. NT-proBNP is usually increased in patients with left ventricular dysfunction, regardless of the presence of symptoms [21]

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