American Heart Journal
Volume 158, Issue 3 , Pages e27-e34 , September 2009

Mechanisms of exercise intolerance in patients with hypertrophic cardiomyopathy

  • Vy-Van Le, MD

      Affiliations

    • Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA
    • Department of Cardiology, VAPAHCS, Palo Alto, CA
    • Corresponding Author InformationReprint requests: Vy-Van Le, MD, Division of Cardiovascular Medicine, Falk CVRC, Stanford University, 300 Pasteur Drive Stanford, CA 94305.
  • ,
  • Marco V. Perez, MD

      Affiliations

    • Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA
  • ,
  • Matthew T. Wheeler, MD, PhD

      Affiliations

    • Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA
  • ,
  • Jonathan Myers, PhD

      Affiliations

    • Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA
    • Department of Cardiology, VAPAHCS, Palo Alto, CA
  • ,
  • Ingela Schnittger, MD

      Affiliations

    • Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA
  • ,
  • Euan A. Ashley, MRCP, DPhil

      Affiliations

    • Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA

Received 13 March 2009 ,Accepted 5 June 2009.

References 

  1. Lele SS, Thomson HL, Seo H, et al. Exercise capacity in hypertrophic cardiomyopathy. Role of stroke volume limitation, heart rate, and diastolic filling characteristics. Circulation. 1995;92:2886–2894
  2. Binder J, Ommen SR, Gersh BJ, et al. Echocardiography-guided genetic testing in hypertrophic cardiomyopathy: septal morphological features predict the presence of myofilament mutations. Mayo Clin Proc. 2006;81:459–467
  3. Maron MS, Olivotto I, Zenovich AG, et al. Hypertrophic cardiomyopathy is predominantly a disease of left ventricular outflow tract obstruction. Circulation. 2006;114:2232–2239
  4. American College of Sports Medicine . Guidelines for exercise testing and prescription. Philadelphia: Lippincott, Williams, and Wilkins; 2000;
  5. Myers J, Buchanan N, Walsh D, et al. Comparison of the ramp versus standard exercise protocols. J Am Coll Cardiol. 1991;17:1334–1342
  6. Guazzi M, Myers J, Arena R. Cardiopulmonary exercise testing in the clinical and prognostic assessment of diastolic heart failure. J Am Coll Cardiol. 2005;46:1883–1890
  7. Matsumura Y, Elliott PM, Virdee MS, et al. Left ventricular diastolic function assessed using Doppler tissue imaging in patients with hypertrophic cardiomyopathy: relation to symptoms and exercise capacity. Heart. 2002;87:247–251
  8. Ha JW, Cho JR, Kim JM, et al. Tissue Doppler-derived indices predict exercise capacity in patients with apical hypertrophic cardiomyopathy. Chest. 2005;128:3428–3433
  9. Myers J, Do D, Herbert W, et al. A nomogram to predict exercise capacity from a specific activity questionnaire and clinical data. Am J Cardiol. 1994;73:591–596
  10. Medicine ACos . Guidelines for Exercise Testing and Prescription. 6th ed. Philadelphia: Lippincott: Williams, and Wilkins; 2000;
  11. Sharma S, Elliott P, Whyte G, et al. Utility of cardiopulmonary exercise in the assessment of clinical determinants of functional capacity in hypertrophic cardiomyopathy. Am J Cardiol. 2000;86:162–168
  12. Wasserman K, Hansen JE, Sue DY, et al. Principles of exercise testing and interpretation. Baltimore: Lippincott: Williams and Wilkins; 2004;
  13. Arena R, Myers J, Aslam SS, et al. Technical considerations related to the minute ventilation/carbon dioxide output slope in patients with heart failure. Chest. 2003;124:720–727
  14. Wasserman K. Breathing during exercise. N Engl J Med. 1978;298:780–785
  15. Richardson P, McKenna W, Bristow M, et al. Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of cardiomyopathies. Circulation. 1996;93:841–842
  16. Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18:1440–1463
  17. Guazzi M, Samaja M, Arena R, et al. Long-term use of sildenafil in the therapeutic management of heart failure. J Am Coll Cardiol. 2007;50:2136–2144
  18. Maron BJ, Spirito P, Green KJ, et al. Noninvasive assessment of left ventricular diastolic function by pulsed Doppler echocardiography in patients with hypertrophic cardiomyopathy. J Am Coll Cardiol. 1987;10:733–742
  19. Stoddard MF, Pearson AC, Kern MJ, et al. Influence of alteration in preload on the pattern of left ventricular diastolic filling as assessed by Doppler echocardiography in humans. Circulation. 1989;79:1226–1236
  20. Nihoyannopoulos P, Karatasakis G, Frenneaux M, et al. Diastolic function in hypertrophic cardiomyopathy: relation to exercise capacity. J Am Coll Cardiol. 1992;19:536–540
  21. Sohn DW, Chai IH, Lee DJ, et al. Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol. 1997;30:474–480
  22. Ommen SR, Nishimura RA, Hurrell DG, et al. Assessment of right atrial pressure with 2-dimensional and Doppler echocardiography: a simultaneous catheterization and echocardiographic study. Mayo Clin Proc. 2000;75:24–29
  23. Nistri S, Olivotto I, Betocchi S, et al. Prognostic significance of left atrial size in patients with hypertrophic cardiomyopathy (from the Italian Registry for Hypertrophic Cardiomyopathy). Am J Cardiol. 2006;98:960–965
  24. Moller JE, Hillis GS, Oh JK, et al. Left atrial volume: a powerful predictor of survival after acute myocardial infarction. Circulation. 2003;107:2207–2212
  25. Shah JS, Tome Esteban MT, Thaman R, et al. Prevalence of exercise induced left ventricular outflow tract obstruction in symptomatic patients with non-obstructive hypertrophic cardiomyopathy. Heart. 2007;
  26. Geske JB, Sorajja P, Nishimura RA, et al. Evaluation of left ventricular filling pressures by Doppler echocardiography in patients with hypertrophic cardiomyopathy: correlation with direct left atrial pressure measurement at cardiac catheterization. Circulation. 2007;116:2702–2708

PII: S0002-8703(09)00448-7

doi: 10.1016/j.ahj.2009.06.006

American Heart Journal
Volume 158, Issue 3 , Pages e27-e34 , September 2009