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Relation of exercise intolerance and left ventricular diastolic function to myocardial fibrosis in the patients with hypertrophic cardiomyopathy
Authors : JW Hwang (Seoul,KR), SUNG M Kim (Seoul,KR), SUNG-J Park (Seoul,KR), EUN K Kim (Seoul,KR), SUNG-A Chang (Seoul,KR), SANG-C Lee (Seoul,KR), YEON H Choe (Seoul,KR), S WOO Park (Seoul,KR), DARAE Kim (Seoul,KR), JIN-OH Choi (Seoul,KR), HA J Kim (Seoul,KR), SEON H Ok (Seoul,KR)
Myocardial fibrosis happened to increased left ventricular (LV) stiffness and higher LV filling pressure likewise diastolic dysfunction, as associated with clinical outcomes in patients with hypertrophic cardiomyopathy (HCMP). Additionally, reduced exercise capacity affected patients along a broad spectrum of clinical severity. The aim of study was to determine the relation between exercise intolerance and LV diastolic parameters to myocardial fibrosis in the patients with HCMP.
We enrolled 289 patients with HCMP and normal LV systolic function (ejection fraction >50%). Study populations underwent both cardiopulmonary exercise test (CPET) as estimating peak oxygen consumption (peak VO2) and cardiac magnetic resonance (CMR) as myocardial fibrosis by late gadolinium delayed enhancement (LGE). NT-proBNP levels were determined at baseline. Basic echocardiography was used to measure the diastolic parameters.
The study population was included with 248 males (85.8%), and the median age of population was 53 years [interquartile range (IQR) 46–60]. Median follow-up was 6.5 years (IQR 3.2–8.6). The median value of Peak VO2 as a representation of exercise tolerance was 29.0 ml/kg/min (IQR 25.0–34.0) in study population. The amount of LGE on CMR was 14.27 mL (IQR 6.30–27.76). The median value of diastolic parameters as left atrium volume index (LAVI) and E/e' ratio, respectively, were 39.10 mL/m2 (IQR 31.30–47.25) and 10.88 (IQR 8.58–13.31). The median NT-proBNP level was 295.40pg/mL (IQR 139.10–687.70). After adjusting for age and gender, peak VO2 was inversely correlated with NT-proBNP (r=−0.274, p<0.001). A linear regression analysis with adjusting age and gender showed that LAVI and E/e' as diastolic parameters could predict the peak VO2 (LAVI: β=−0.082, p<0.001, E/e': β=−0.373, p<0.001) and NT-proBNP (LAVI: β=11.454, p<0.001, E/e': β=55.533, p<0.001), as well as the LGE also could associate the peak VO2 (LGE: β=−0.075, p<0.001) and NT-proBNP (LGE: β=16.194, p<0.001).
In conclusion, through the correlation among exercise tolerance, parameters of diastolic dysfunction, and myocardial fibrosis, we demonstrated that exercise intolerance and parameters of diastolic dysfunction could predict the myocardial fibrosis in patients with HCMP. We inferred the adverse effects of myocardial fibrosis, as assessed by LGE, lead to diastolic dysfunction and reduced the exercise tolerance.