Cardio-circulatory exercise response in AL amyloidosis and comparison with hypertrophic cardiomyopathy - 17/04/19
Résumé |
Introduction |
Cardiopulmonary exercise test (CPET) can help the physician in understanding mechanisms that underlie patients exercise limitation. We aimed to characterize exercise response in AL amyloidosis through CPET and to compare it with hypertrophic sarcomeric cardiomyopathy (HCM).
Methods |
We prospectively included 49 patients: 24 with cardiac amyloidosis (group A), 10 with amyloidosis without cardiac involvement (group B) and 15 HCM (groupC). All were clinically stable and underwent clinical examination, ECG, echocardiography, cardiac MRI and CPET. CPET assessed systolic blood pressure (SBP) as well as heart rate (HR) responses, O2 pulse response, peak VO2, circulatory power (SBPxVO2) and VE/VCO2slope.
Results |
The SBP response was 25mmHg in group A from rest to peak exercise, 19mmHg in group B and 49mmHg in group C (P<0.05). Circulatory power was 2073 mmHg.mL−1min_1 in group A, 2620 mmHg.mL−1min_1 in group B and 4040 mmHg.mL−1min_1 in group C (P<0.05). A chronotropic incompetence was observed in 46% of group A and 44% in group B versus 7% in group C (P<0.05). Peak VO2 was 14mL.min.Kg−1in group A, 19mL.min.Kg−1in group B and 20mL.min.Kg−1in group C (P<0.05). The increase of O2 pulse during exercise was 2 in group A versus 3 in group B and group C (P<0.05). The VE/VCO2slope was increased in group A compared to group B and C (respectively 40 vs. 31 and 30, P<0.05).
Conclusion |
CPET quantifies and specifies determinants of the poor cardio-circulatory response during exercise in AL amyloidosis patients, including decrease of peak VO2 and low circulatory power suggestive of poor exercise inotropic reserve; a chronotropic incompetence that can be related to cardiac dysautonomia and an increase of VE/VCO2 slope suggestive of exercise pulmonary hypertension.
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Vol 11 - N° 1P2
P. e288-e289 - avril 2019 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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