scholarly journals Predictors of Exercise Capacity in Patients with Hypertrophic Obstructive Cardiomyopathy

2018 ◽  
Vol 7 (11) ◽  
pp. 447 ◽  
Author(s):  
Joshua Smith ◽  
Jose Medina-Inojosa ◽  
Veronica Layrisse ◽  
Steve Ommen ◽  
Thomas Olson
Keyword(s):  
Exercise Capacity ◽  
Left Atrial ◽  
Cardiopulmonary Exercise Testing ◽  
Left Atrial Volume ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Volume Index ◽  
Atrial Volume ◽  
Left Atrial Volume Index ◽  
Peak Vo2 ◽  
History Of

Hypertrophic obstructive cardiomyopathy (HOCM) patients exhibit compromised peak exercise capacity (VO2peak). Importantly, severely reduced VO2peak is directly related to increased morbidity and mortality in these patients. Therefore, we sought to determine clinical predictors of VO2peak in HOCM patients. HOCM patients who performed symptom-limited cardiopulmonary exercise testing between 1995 and 2016 were included for analysis. Peak VO2 was reported as absolute peak VO2, indexed to body weight and analyzed as quartiles, with quartile 1 representing the lowest VO2peak. Step-wise regression models using demographic features and clinical and physiologic characteristics were created to determine predictors of HOCM patients with the lowest VO2peak. We included 1177 HOCM patients (age: 53 ± 14 years; BMI: 24 ± 12 kg/m2) with a VO2peak of 18.0 ± 5.6 mL/kg/min. Significant univariate predictors of the lowest VO2peak included age, female sex, New York Health Association (NYHA) class, BMI, left atrial volume index, E/e’, E/A, hemoglobin, N-terminal pro b-type natriuretic peptide (NT-proBNP), and a history of diabetes, hypertension, stroke, atrial fibrillation, or coronary artery disease. Independent predictors of the lowest VO2peak included age (OR, CI: 1.03, 1.02–1.06; p < 0.0001), women (4.66, 2.94–7.47; p = 0.001), a history of diabetes (2.05, 1.17–3.60; p = 0.01), BMI (0.94, 0.92–0.96; p < 0.0001), left atrial volume index (1.07, 1.05–1.21; p = 0.04), E/e’ (1.05, 1.01–1.08; p = 0.004), hemoglobin (0.76, 0.65–0.88; p = 0.0004), and NT-proBNP (1.72, 1.42–2.11; p < 0.0001). These findings demonstrate that demographic factors (i.e., age and sex), comorbidities (e.g., diabetes and obesity), echocardiography indices, and biomarkers (e.g., hemoglobin and NT-proBNP) are predictive of severely compromised VO2peak in HOCM patients.

Abstract 17191: Left Atrial Volume Index and E/E’ Predict Predominance of Post-Capillary Pulmonary Hypertension With Exercise Hemodynamics

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Naga Dharmavaram ◽  
Aurangzeb Baber ◽  
Sofia C Masri ◽  
Ravi Dhingra ◽  
James Runo ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Left Atrial ◽  
Cardiopulmonary Exercise Testing ◽  
Left Atrial Volume ◽  
Venous Hypertension ◽  
Volume Index ◽  
Atrial Volume ◽  
Left Atrial Volume Index ◽  
Group 2 ◽  
Group 1

Introduction: Post-capillary pulmonary hypertension (PH) is diagnosed with rest hemodynamics and requires management of left heart disease. However, in subclinical PH and mixed PH (mixed pre- and post-capillary), it is imperative to identify a predominant post-capillary phenotype with exercise (aka. Pulmonary venous hypertension). Hypothesis: In suspected subclinical and mixed PH, greater left atrial volume index (LAVI; >35) and E/E’ (>8) on echocardiogram can reliably predict a predominant post-capillary PH with exercise, assessed with invasive cardiopulmonary exercise testing (iCPET). Methods: We reviewed clinical, echocardiographic and iCPET data for 37 patients undergoing exercise right heart catheterization and then analyzed the data with receiver operator curve (ROC) and area under the curve (AUC) analysis to estimate the different echo parameters to identify post-capillary PH. Results: Within the cohort, mean age (± SD) was 63.6±11.3 years, and 19 subjects were female (51%). On ROC analysis, LAVI and E/E’ had high predictive ability to identify a pulmonary venous hypertension response with exercise (AUC=0.860, p=0.003 for LAVI, and AUC=0.788, p=0.014) with optimal cut-offs identified as: LAVI >35 and E/E’ >8. These variables also notably had a significant association with PCWP/CO>2. To understand the hemodynamics associated with these differentiable echo features, we divided the overall cohort (n=37) into 2 groups: group 1 ( Abnormal-LA group ) =LAVI>35 and/or E/E’ >8, group 2 ( Normal-LA group )=LAVI≤ 34 and E/E’≤8. The LAVI in group 1 vs group 2 was: 44.3±15.2 vs 23.1±4.4 (p<0.001) and E/E’ was: 15.8±9.9 vs 7.7±1.95 (p<0.01). Results are summarized in Table 1. Conclusions: Among individuals with suspected PH, LAVI>35 and E/E’ >8 are reliable non-invasive markers to identify post-capillary PH. In a patient with a new diagnosis of PH based on screening echocardiogram, LAVI≤ 34 and E/E’≤8 may identify a patient who is likely to benefit from PH drugs.

scholarly journals Right atrial to left atrial volume index ratio is associated with increased mortality in patients with pulmonary hypertension

2018 ◽  
Vol 35 (11) ◽  
pp. 1729-1735 ◽  
Author(s):  
Manu M. Mysore ◽  
Kenneth C. Bilchick ◽  
Priscilla Ababio ◽  
Benjamin K. Ruth ◽  
William C. Harding ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Right Atrial ◽  
Volume Index ◽  
Atrial Volume ◽  
Left Atrial Volume Index ◽  
Index Ratio

Abstract 4205: Left Atrial Volume Index and Left Ventricular Geometry Independently Predict Mortality in 47,865 Patients with Preserved Ejection Fraction

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Dharmendrakumar A Patel ◽  
Carl J Lavie ◽  
Richard V Milani ◽  
Hector O Ventura
Keyword(s):  
Ejection Fraction ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Mortality Prediction ◽  
Volume Index ◽  
Left Ventricular Geometry ◽  
Preserved Ejection Fraction ◽  
Atrial Volume ◽  
Left Atrial Volume Index

Background: LV geometry predicts CV events but it is unknown whether left atrial volume index (LAVi) predicts mortality independent of LV geometry in patients with preserved LVEF. Methods: We evaluated 47,865 patients with preserved EF to determine the impact of LAVi and LV geometry on mortality during an average follow-up of 1.7±1.0 years. Results: Deceased patients (n=3,653) had significantly higher LAVi (35.3 ± 15.9 vs. 29.1 ± 11.9, p<0.0001) and abnormal LV geometry (60% vs. 41%, p<0.0001) than survivors (n=44,212). LAVi was an independent predictor of mortality in all four LV geometry groups [Hazard ratio: N= 1.007 (1.002–1.011), p=0.002; concentric remodeling= 1.008 (1.001–1.012), p<0.0001; eccentric hypertrophy= 1.012 (1.006 –1.018), p<0.0001; concentric hypertrophy=1.017 (1.012–1.022), p<0.0001; Figure ]. Comparison of models with and without LAVi for mortality prediction was significant suggesting increased mortality prediction by addition of LAVi to other independent predictors (Table ). Conclusion: LAVi is higher and LV geometric abnormalities are more prevalent in deceased patients with preserved systolic function and are independently associated with increased mortality. LAVi predicts mortality independent of LV geometry and has synergistic influence on all cause mortality prediction in large cohort of patients with preserved ejection fraction.

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