Usefulness of exercise stress echocardiography for predicting cardiovascular events and atrial fibrillation in hypertrophic cardiomyopathy

Tomohiro Yoshii; Masashi Amano; Kenji Moriuchi; Shoko Nakagawa; Hitomi Nishimura; Yurie Tamai; Ayaka Mizumoto; Aiko Koda; Yutaka Demura; Yoshito Jo; Yuki Irie; Takahiro Sakamoto; Makoto Amaki; Hideaki Kanzaki; Teruo Noguchi; Kunihiro Nishimura; Takeshi Kitai; Chisato Izumi

doi:10.1016/j.jjcc.2024.08.010

Usefulness of exercise stress echocardiography for predicting cardiovascular events and atrial fibrillation in hypertrophic cardiomyopathy

J Cardiol. 2024 Aug 28:S0914-5087(24)00170-9. doi: 10.1016/j.jjcc.2024.08.010. Online ahead of print.

Authors

Tomohiro Yoshii¹, Masashi Amano², Kenji Moriuchi¹, Shoko Nakagawa¹, Hitomi Nishimura³, Yurie Tamai³, Ayaka Mizumoto³, Aiko Koda³, Yutaka Demura³, Yoshito Jo³, Yuki Irie¹, Takahiro Sakamoto¹, Makoto Amaki¹, Hideaki Kanzaki¹, Teruo Noguchi⁴, Kunihiro Nishimura⁵, Takeshi Kitai¹, Chisato Izumi¹

Affiliations

¹ Department of Heart Failure and Transplant, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
² Department of Heart Failure and Transplant, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. Electronic address: m.amano@ncvc.go.jp.
³ Department of Clinical Laboratory, National Cerebral and Cardiovascular Center, Suita, Japan.
⁴ Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
⁵ Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.

PMID: 39214510
DOI: 10.1016/j.jjcc.2024.08.010

Abstract

Background: In hypertrophic cardiomyopathy (HCM), the determinants of exercise tolerance and the usefulness of exercise stress echocardiography (ESE) for predicting hard endpoints have not been fully investigated. We aimed to assess the key parameters of ESE for exercise tolerance and the factors predictive of cardiovascular events and new-onset atrial fibrillation (AF) in patients with HCM.

Methods: Seventy-four consecutive patients with HCM who underwent ESE and with an ejection fraction ≥50 % were enrolled. The primary endpoint was a composite of cardiovascular death, heart failure hospitalization, ventricular fibrillation or tachycardia, and ventricular assist device implantation. The secondary endpoint was new-onset AF.

Results: The primary endpoint occurred in 13 patients. The left and right ventricular functions during exercise were responsible for decreased exercise tolerance. Peak exercise e' and tricuspid annular plane systolic excursion (TAPSE) significantly predicted increased primary outcome risk (hazard ratio 1.35, 95 % confidence interval 1.10-1.76, p = 0.003; hazard ratio 1.19, 95 % confidence interval 1.07-1.32, p = 0.002, respectively), and the results were consistent even after adjustment by maximum workload. These ESE parameters improved the prognostic model containing estimated glomerular filtration rate (eGFR) and left atrial (LA) volume index. In AF-naive patients (n = 58), LA volume, peak exercise LA reservoir strain, and left ventricular outflow tract (LVOT) pressure gradient predicted new-onset AF.

Conclusions: In patients with HCM, ESE parameters related to left and right ventricular function were responsible for low exercise tolerance. Furthermore, e' and TAPSE at peak workload could be useful for predicting cardiovascular events in addition to eGFR and LA volume index. LVOT pressure gradient and LA function during exercise predicted new-onset AF.

Keywords: Atrial fibrillation; Cardiovascular events; Echocardiography; Hypertrophic cardiomyopathy.