Carotid arterial stiffness is increased and related to left ventricular function in patients with hypertrophic cardiomyopathy

Roşca, Monica; Mandeş, Leonard; Ciuperca, D; Călin, Andreea; Beladan, Carmen C.; Enache, Roxana; Jurcuţ, Ruxandra; Coman, Ioan Mircea; Ginghină, Carmen; Popescu, Bogdan A

doi:10.1093/ehjci/jez243

Cited by 1 publication

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“…HCM patients presenting B-lines at stress were diagnosed with HCM later in life and had higher SCD risk scores. They showed higher pulse pressure at rest, with similar heart rate and cardiac output compared to patients without stress B-lines, suggestive of a stiff aorta which may contribute to abnormal ventricular arterial interactions during stress eventually favouring myocardial fibrosis and dysfunction (15,16). Stress B-lines were associated with worse diastolic function, greater SPAP and larger increment in MR during stress.…”

Section: Discussionmentioning

confidence: 86%

Pulmonary congestion during Exercise stress Echocardiography in Hypertrophic Cardiomyopathy

Peteiro

Tešić

et al. 2022

Int J Cardiovasc Imaging

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Background B-lines detected by lung ultrasound (LUS) during exercise stress echocardiography (ESE), indicating pulmonary congestion, have not been systematically evaluated in patients with hypertrophic cardiomyopathy (HCM). Aim To assess the clinical, anatomical and functional correlates of pulmonary congestion elicited by exercise in HCM. Methods We enrolled 128 HCM patients (age 52 ± 15 years, 72 males) consecutively referred for ESE (treadmill in 46, bicycle in 82 patients) in 10 quality-controlled centers from 7 countries (Belgium, Brazil, Bulgaria, Hungary, Italy, Serbia, Spain). ESE assessment at rest and peak stress included: mitral regurgitation (MR, score from 0 to 3); E/e’; systolic pulmonary arterial pressure (SPAP) and end-diastolic volume (EDV). Change from rest to stress was calculated for each variable. Reduced preload reserve was defined by a decrease in EDV during exercise. B-lines at rest and at peak exercise were assessed by lung ultrasound with the 4-site simplified scan. B-lines positivity was considered if the sum of detected B-lines was ≥ 2. Results LUS was feasible in all subjects. B-lines were present in 13 patients at rest and in 38 during stress (10 vs 30%, p < 0.0001). When compared to patients without stress B-lines (n = 90), patients with B-lines (n = 38) had higher resting E/e’ (14 ± 6 vs. 11 ± 4, p = 0.016) and SPAP (33 ± 10 vs. 27 ± 7 mm Hg p = 0.002). At peak exercise, patients with B-lines had higher peak E/e’ (17 ± 6 vs. 13 ± 5 p = 0.003) and stress SPAP (55 ± 18 vs. 40 ± 12 mm Hg p < 0.0001), reduced preload reserve (68 vs. 30%, p = 0.001) and an increase in MR (42 vs. 17%, p = 0.013) compared to patients without congestion. Among baseline parameters, the number of B-lines and SPAP were the only independent predictors of exercise pulmonary congestion. Conclusions Two-thirds of HCM patients who develop pulmonary congestion on exercise had no evidence of B-lines at rest. Diastolic impairment and mitral regurgitation were key determinants of pulmonary congestion during ESE. These findings underscore the importance of evaluating hemodynamic stability by physiological stress in HCM, particularly in the presence of unexplained symptoms and functional limitation.

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Section: Discussionmentioning

confidence: 86%