Differential exercise blood pressure response in patients with hypertrophic, non-obstructive cardiomyopathy compared to patients with heart failure and preserved ejection fraction
Notice bibliographique
Résumé
Abstract Background Exercise blood pressure response is not well characterized in patients with left ventricular hypertrophy, such as in patients with heart failure and preserved ejection fraction (HFpEF) or hypertrophic, non-obstructive cardiomyopathy (HCM). Peak systolic blood pressure (SBPpeak) or increase of systolic blood pressure from rest to peak exercise (SBPsupine-to peak) may be used to risk stratify patients. However, SBPpeak depends on cardiac output (CO), which is not measured routinely during exercise testing: Relating the slope of SBP to workload during exercise may better reflect adequate peripheral adaptations to exercise. While SBP/W>0.53mmHg/W has been associated with increased mortality in HFpEF, the prognostic utility of SBP/W in HCM remains unknown. Purpose To evaluate blood pressure response during exercise in relation to workload in HFpEF and HCM patients and assess its prognostic utility. Methods This is a retrospective, single-centre analysis of clinically stable HFpEF and HCM patients and a left ventricular ejection fraction ≥50% without previous rhythmogenic events. Patients reported to our outpatient clinic for elective, exertional bicycle ergometry testing and were followed-up for 4 years. Hospitalizations and cardiovascular events were assessed from the beginning to the end of the study period. Differences between SBPpeak, SBPsupine-to peak as well as SBP/W slope were compared between HCM and HFpEF patients with a level of significance of α = 0.05. Results A total of 52 patients were included (HCM: n=21, 5 females. HFpEF: n=31, 18 females, p<.001 for age). HFpEF patients were significantly older (mean age 71.8+/−18.0 years vs. 53.7+/−17.9 years, p<.001) and showed lower overall performance (132.4+/− 63.8W vs. 271.6+/−81.6W, p<.001). Hypertension at rest (HCM: n=10, HFpEF: n=20; p=0.391) and BMI (HCM: 25.0 +/− 2.7kg/m2, HFpEF: 25.7 +/− 6.6kg/m2, p=0.238) did not differ between groups. SBPpeak (207.6+/−26.5 mmHg vs. 181.7+/− 32.1mmHg, p=0.001) and SBPsupine-to peak (76.0+/−23.8 mmHg vs. 50.6+/− 25.0mmHg, p=0.001) were higher in HCM compared to HFpEF. SBP/W (0.7+/− 0.3mmHg/W vs. 0.6+/− 0.3mmHg/W, p=0.321) did not differ between HCM and HFpEF patients. In 3 out of 4 hospitalized HFpEF patients SBP/W slope was elevated (0.8, 1.0, and 1.1mmHg/W), while SBPpeak (140, 190, 200mmHg) and SBPsupine-to peak (40, 70, 80mmHg) were reduced or within normal range. Despite higher SBPpeak and SBPsupine-to peak in HCM, there were no hospitalizations or arrhythmic events. Conclusions SBP/W slope is comparable between HCM and HFpEF, but its prognostic utility in HCM remains unclear. Higher SBPpeak and SBPsupine-to peak in this young cohort of HCM patients may be the result of higher CO as a physiological response to exercise.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».