Circulation, Vol 82, 1995-2002, Copyright © 1990 by American Heart Association
MP Frenneaux, PJ Counihan, AL Caforio, T Chikamori and WJ McKenna
To investigate the incidence of abnormal exercise blood pressure responses
in hypertrophic cardiomyopathy (HCM) and the potential role of hemodynamic
instability as a mechanism of sudden death, 129 consecutive patients with
HCM underwent maximal symptom-limited treadmill exercise testing with blood
pressure recording. Four patterns of blood pressure response were observed.
Forty-three patients had significant exercise hypotension, with either a
continuous fall in systolic blood pressure (n = 5) from the start of
exercise or a sudden fall in systolic blood pressure (20-100 mm Hg; mean,
40 mm Hg) from the peak value (n = 38), 23 patients had a normal response
during exercise but an abnormal blood pressure response in the recovery
period, and the remaining 62 patients demonstrated a normal blood pressure
response. Patients with exercise hypotension were younger (33 +/- 14 versus
46 +/- 14 years) and more of them had a family history of HCM and sudden
death compared with those with a normal blood pressure response (15 of 43
versus 6 of 62 patients). Similarly, the 23 patients with abnormal recovery
blood pressure responses were younger (43 +/- 16 versus 46 +/- 14 years)
and had a higher incidence of a family history of sudden death (10 of 24
versus 6 of 62 patients). Left ventricular cavity dimensions were smaller
in those with exercise hypotension, but 11 other clinical,
echocardiographic, and arrhythmic variables were similar. To assess the
mechanism of exercise hypotension, 14 patients who demonstrated exercise
hypotension and 14 symptomatic patients with a normal exercise blood
pressure response underwent invasive hemodynamic exercise testing.(ABSTRACT
TRUNCATED AT 250 WORDS)
ARTICLES
Abnormal blood pressure response during exercise in hypertrophic cardiomyopathy
Department of Cardiological Sciences, St. George's Hospital Medical School, London, England.
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