The evolution of the arterial pressure during a stress test in patients with hypertrophic myocardiopathy

OBJECTIVES: To study the exercise blood pressure response in patients with hypertrophic cardiomyopathy (HC) and its relationship with sudden death. DESIGN: Retrospective study. POPULATION: We studied 51 patients (P) with HC: 18 women and 33 men. Their average age was 45 +/- 14 years, with a mean follow-up of 55 +/- 37 months. METHODS: Every patient had been subjected to a treadmill stress-test, a 24-hour Holter monitoring and an echocardiographic examination. Particular emphasis was given to blood pressure increments (BPI) during stress-test, the existence of premature ventricular contractions with a frequency of 10 or more per hour (PVC > or = 10), the occurrence of couplets (C) and/or non-sustained ventricular tachycardia (NSVT) on a 24-hour Holter. Finally, the finding of systolic anterior motion (SAM) of the mitral valve, in the routine echocardiogram, was valued. RESULTS: Four patterns of BPI were identified: "1": normal evolution (27 P); "2": plateau type increment (16 P); "3": fall in blood pressure during exercise (6 P); "4": abnormal BPI during recovery (2 P). Two groups were considered: group N-normal BPI, group A-patients with abnormal blood pressure responses. There were no significant differences among therapeutic agents, between the two groups, when the stress-test was performed. SAM was found in 21 P. Only 8 P registered ventricular arrhythmias, half of them with NSVT. No statistical relations were found between BPI and P age, the presence of SAM, PVC > or = 10, C, or NSVT. We found 78% of P in group N in NYHA class I. In contrast, in group A only 46% were in class I (p = 0.04). Only one death, of non cardiac cause, occurred (group A). CONCLUSIONS: There is a large number of patients with HC and abnormal BPI. This is, seemingly, not influenced either by a dynamic left ventricular gradient or by ventricular ectopic beat occurrence. However, a relation appears to exist between the abnormal response and functional class, not explained by the usual (noninvasive) clinical tests.