Exercise capacity and paroxysmal atrial fibrillation in patients with hypertrophic cardiomyopathy

Azarbal, Farnaz; Singh, Maneesh H.; Finocchiaro, Gherardo; Le, Vy‐Van; Schnittger, Ingela; Wang, Paul; Myers, Jonathan; Ashley, Euan A.; Pérez, Marco

doi:10.1136/heartjnl-2013-304908

Cited by 38 publications

(23 citation statements)

References 29 publications

(30 reference statements)

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“…Atrial fibrillation is also the most common arrhythmia among hypertrophic cardiomyopathy patients. Such patients with concomitant paroxysmal AF have generally exercise intolerance, despite sinus rhythm at the exercise time [9]. There may be evidence that years of striving the heart to pump great volumes of blood for hours at a time, lead to long-term heart damage and, in fact, turn big health advantages of the aerobic exercise back.…”

Section: Discussionmentioning

confidence: 99%

Military jet pilots have higher p-wave dispersions compared to the transport aircraft aircrew

Çakar

Metin

Balta

et al. 2016

Int J Occup Med Environ Health

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Objectives: For the purpose of flight safety military aircrew must be healthy. P-wave dispersion (PWD) is the p-wave length difference in an electrocardiographic (ECG) examination and represents the risk of developing atrial fibrillation. In the study we aimed at investigating PWD in healthy military aircrew who reported for periodical examinations. Material and Methods: Seventy-five asymptomatic military aircrew were enrolled in the study. All the subjects underwent physical, radiologic and biochemical examinations, and a 12-lead electrocardiography. P-wave dispersions were calculated. Results: The mean age of the study participants was 36.15±8.97 years and the mean p-wave duration was 100.8±12 ms in the whole group. Forty-seven subjects were non-pilot aircrew, and 28 were pilots. Thirteen study subjects were serving in jets, 49 in helicopters, and 13 were transport aircraft pilots. Thirty-six of the helicopter and 11 of the transport aircraft aircrew were non-pilot aircrew. P-wave dispersion was the lowest in the transport aircraft aircrew, and the highest in jet pilots. P-wave dispersions were similar in the pilots and non-pilot aircrew. Twenty-three study subjects were overweight, 19 had thyroiditis, 26 had hepatosteatosis, 4 had hyperbilirubinemia, 2 had hypertension, and 5 had hyperlipidemia. The PWD was significantly associated with thyroid-stimulating hormone (TSH) levels. Serum uric acid levels were associated with p-wave durations. Serum TSH levels were the most important predictor of PWD. Conclusions: When TSH levels were associated with PWD, uric acid levels were associated with p-wave duration in the military aircrew. The jet pilots had higher PWDs. These findings reveal that military jet pilots may have a higher risk of developing atrial fibrillation, and PWD should be recorded during periodical examinations. MATERIAL AND METHODS SubjectsThe study was conducted in a secondary military referral health center. Our hospital is also a center for the yearly and 5-year periodical examinations of military aircrew. A total of 75 military aircrew, all of whom were male, reporting for 5-year periodical examinations were enrolled in the study. Military non-pilot aircrew are people helping with search-rescue jobs, transporting objects, carrying goods needed for the flight, etc., who fly with pilots together in helicopters and in transport aircrafts. Physical examination, blood pressure (BP) and anthropometric measurements were performed as part of the 5-year periodical examinations. The examinations also included obtaining information on the type of the aircraft they serve in, their tasks, drug history, smoking, alcohol usage and past medical history. Complete blood count, renal and hepatic function tests, electrolytes, serum lipid levels, thyroid hormones, serum thyroid antibodies, electrocardiographic and echocardiographic examinations were also performed within the examinations. Exclusion criteria for the study participants were: refusal to participate in the study, smoking, uncontrolled hypertensi...

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Section: Discussionmentioning

confidence: 99%

Military jet pilots have higher p-wave dispersions compared to the transport aircraft aircrew

Çakar

Metin

Balta

et al. 2016

Int J Occup Med Environ Health

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“…Exercise intolerance is not only uniformly observed in patients with heart failure but is generally an early sign of cardiac dysfunction that precedes evidence of reduced baseline function at rest (2,5,26,37,53). However, exercise capacity is rarely examined in mouse models of cardiomyopathy, and has not been examined in transgenic mice, where ␤-AR signaling is chronically enhanced.…”

Section: Discussionmentioning

confidence: 99%

Disruption of type 5 adenylyl cyclase prevents β-adrenergic receptor cardiomyopathy: A novel approach to β-adrenergic receptor blockade

Yan

Vatner

2014

American Journal of Physiology-Heart and Circulatory Physiology

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Yan L, Vatner SF, Vatner DE. Disruption of type 5 adenylyl cyclase prevents ␤-adrenergic receptor cardiomyopathy: A novel approach to ␤-adrenergic receptor blockade. Am J Physiol Heart Circ Physiol 307: H1521-H1528, 2014. First published September 5, 2014; doi:10.1152/ajpheart.00491.2014.-␤-Adrenergic receptor (␤-AR) blockade is widely used to treat heart failure, since the adverse effects of chronic ␤-AR stimulation are central to the pathogenesis of this disease state. Transgenic (Tg) mice, where ␤-AR signaling is chronically enhanced by overexpression of cardiac ␤ 2-ARs, is a surrogate for this mechanism, since these mice develop cardiomyopathy as reflected by reduced left ventricular (LV) function, increased fibrosis, apoptosis, and myocyte hypertrophy. We hypothesized that disruption of type 5 adenylyl cyclase (AC5), which is in the ␤-AR signaling pathway in the heart, but exerts only a minor ␤-AR blocking effect, could prevent the cardiomyopathy in ␤2-AR Tg mice without the negative effects of full ␤-AR blockade. Accordingly, we mated ␤2-AR Tg mice with AC5 knockout (KO) mice. The ␤2-AR Tg ϫ AC5 KO bigenic mice prevented the cardiomyopathy as reflected by improved LV ejection fraction, reduced apoptosis, fibrosis, and myocyte size and preserved exercise capacity. The rescue was not simply due to a ␤-blocking effect of AC5 KO, since neither baseline LV function nor the response to isoproterenol was diminished substantially compared with the negative inotropic effects of ␤-blockade. However, AC5 disruption in ␤2-AR Tg activates the antioxidant, manganese superoxide dismutase, an important mechanism protecting the heart from cardiomyopathy. These results indicate that disruption of AC5 prevents the cardiomyopathy induced by chronically enhanced ␤-AR signaling in mice with overexpressed ␤2-AR, potentially by enhancing resistance to oxidative stress and apoptosis, suggesting a novel, alternative approach to ␤-AR blockade.

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“…Dyspnoea is common, and reflects high LV filling pressure, diastolic dysfunction or afterload mismatch with mitral regurgitation secondary to LVOTO . In addition, paroxysmal AF has been associated with impaired cardiac reserve, defined as reduced exercise capacity and maximal oxygen consumption . In patients with LVOTO, symptoms are typically variable over time, exacerbated by dehydration, meals, alcohol, use of vasodilators, and squatting.…”

Section: Clinical Profiles and Genesis Of Symptomsmentioning

confidence: 99%

Pharmacological treatment of hypertrophic cardiomyopathy: current practice and novel perspectives

Ammirati

Contri

Coppini

et al. 2016

European J of Heart Fail

109

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Hypertrophic cardiomyopathy (HCM) is entering a phase of intense translational research that holds promise for major advances in disease-specific pharmacological therapy. For over 50 years, however, HCM has largely remained an orphan disease, and patients are still treated with old drugs developed for other conditions. While judicious use of the available armamentarium may control the clinical manifestations of HCM in most patients, specific experience is required in challenging situations, including deciding when not to treat. The present review revisits the time-honoured therapies available for HCM, in a practical perspective reflecting real-world scenarios. Specific agents are presented with doses, titration strategies, pros and cons. Peculiar HCM dilemmas such as treatment of dynamic outflow obstruction, heart failure caused by end-stage progression and prevention of atrial fibrillation and ventricular arrhythmias are assessed. In the near future, the field of HCM drug therapy will rapidly expand, based on ongoing efforts. Approaches such as myocardial metabolic modulation, late sodium current inhibition and allosteric myosin inhibition have moved from pre-clinical to clinical research, and reflect a surge of scientific as well as economic interest by academia and industry alike. These exciting developments, and their implications for future research, are discussed.

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Exercise capacity and paroxysmal atrial fibrillation in patients with hypertrophic cardiomyopathy

Abstract: Patients with HCM and paroxysmal AF demonstrate exercise intolerance despite being in sinus rhythm at the time of exercise testing.

Cited by 38 publications

References 29 publications

Military jet pilots have higher p-wave dispersions compared to the transport aircraft aircrew

Military jet pilots have higher p-wave dispersions compared to the transport aircraft aircrew

Disruption of type 5 adenylyl cyclase prevents β-adrenergic receptor cardiomyopathy: A novel approach to β-adrenergic receptor blockade

Pharmacological treatment of hypertrophic cardiomyopathy: current practice and novel perspectives

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