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- Open Access
The use of multiparametric CMR to predict impaired exercise capacity in hypertrophic cardiomyopathy
© Flett et al; licensee BioMed Central Ltd. 2009
- Published: 28 January 2009
- Diastolic Dysfunction
- Late Gadolinium Enhancement
- Exercise Capacity
- Hypertrophic Cardiomyopathy
- Atrial Pressure
To understand the role of CMR measured parameters including late gadolinium enhancement (LGE) on exercise capacity in patients with hypertrophic cardiomyopathy (HCM).
Exercise intolerance in HCM is complex, depending on multiple factors including diastolic dysfunction, outflow tract obstruction, ischemia, left atrial pressure, hypertrophy and fibrosis. We sought to determine the relative contributions of 5 CMR measured variables on exercise capacity in HCM: function, mass, left atrial area, resting LVOT obstruction and LGE.
135 consecutive patients with HCM (median age 46.5 years, 21% female, 67% Caucasian) underwent cardiopulmonary metabolic exercise testing (measuring percent predicted peak oxygen consumption (%pVO2) and contrast CMR (for function, volumes, mass, left atrial area, presence of rest LVOT obstruction and LGE). Two independent investigators blinded to results of the opposing dataset performed analysis of exercise and CMR data. The extent of LGE was categorised as normal/minimal, moderate or extensive (3 point scale, 0, 1 or 2). Univariate and multivariate analysis was used to assess correlations of %pVO2 with CMR derived variables.
The main determinant of significant exercise limitation measured by multiparametric CMR in HCM is the presence of extensive LGE. Lesser amounts of LGE do not predict exercise capacity, highlighting the mulitfactorial nature of functional limitation in this condition.
This article is published under license to BioMed Central Ltd.