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CJAP ›› 2021, Vol. 37 ›› Issue (1): 27-33.doi: 10.12047/j.cjap.0096.2021.101

• ORIGINAL ARTICLES • Previous Articles     Next Articles

Two types of exercise-induced abnormal blood pressure response in hypertrophic cardiomyopathy

HU Xiao-ying1, SUN Xing-guo, QIAO Shu-bin, GAO Xiao-jin1, LUO Xiao-liang1, LIU Fang1, ZHANG Ye1, HAO Lu1,2, SONG Ya1,2, CHEN Ying-zhe1,3, WANG Ji-nan1,2, TAI Wen-qi1, SHI Chao1, XU Fan1, ZHAI Wen-xuan1, YANG Jie1, ZHANG Tian-jing1   

  1. 1. Chinese Academy of Medical Sciences, Peking Union Medical College, National Center for Cardiovascular Diseases, Department of Cardiology,Fuwai Hospital, State Key Laboratory of Cardiovascular Diseases/Chinese Academy of Medical Sciences, Beijing 100037;
    2. The Affiliated Rehabilitation Hospital of Chongqing Medical University, Chongqing 400050;
    3. Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing 100010, China
  • Received:2020-08-12 Revised:2021-01-05 Published:2021-10-21

Abstract: Objective: Insufcient exercise blood pressure response(blunted ABPR) and lower blood pressure during the recovery period (LBP)after exercise are common abnormalities in patients with hypertrophic cardiomyopathy (HCM). The purpose of this study was to analyze the related factors of these two types of abnormal blood pressure response in HCM patients and their relationship with cardiopulmonary function. Methods: A total of 219 consecutive HCM patients who underwent CPET in Fuwai hospital were recruited from April 1, 2018 to Jan 31, 2020 with a complete clinical assessment, including electrocardiography, HOLTER, rest echocardiography and cardiac MRI. One hundred and eleven healthy age- and gender-matched volunteers enrolled as control group. Results: The incidences of blunted ABPR and LBP in HCM patients were much higher than normal control group (8.7% vs 1.8%, P=0.016; 6.8% vs 0.0%, P=0.003, respectively). In HCM group, patients with blunted ABPR combined more coronary artery disease (CAD) (P=0.029), pulmonary hypertension (PH) (P=0.002) and atrial fibrillation/flutter (P=0.036) compared with patients without blunted ABPR. Compared with HCM patients without LBP, the patients with LBP had higher rest left ventricular outflow tract (LVOT) gradient (P=0.017) and left ventricular ejection fraction (P=0.043), more incidence of LVOT obstructive (P=0.015) and systolic anterior motion (P=0.022). After Logistic regression analysis, CAD and PH were independent factor of blunted ABPR, while LBP was only independently associated with rest LVOT gradient. Blunted ABPR was associated with lower Peak VO2, peak heart rate and hear rate reserve, and higher NT-proBNP (P=0.019), VE/VO2 (P=0.000). LBP was not associated with any index of cardiopulmonary function. Conclusion: The incidences of blunted ABPR and LBP in HCM patients were much higher than normal control group. In HCM patients, CAD and PH were independent determinants of blunted ABPR, while LBP was only independently associated with rest LVOT gradient. Patients with blunted ABPR had lower cardiopulmonary function, but LBP was not associated cardiopulmonary function.

Key words: exercise blood pressure response, hypertrophic cardiomyopathy, cardiopulmonary exercise testing, post exercise hypotension

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