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true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Clinical impact of cardiopulmonary exercise testing in hypertrophic cardiomyopathy" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "e15" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Alberto Dominguez-Rodriguez, Nestor Baez-Ferrer, Pedro Abreu-Gonzalez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Alberto" "apellidos" => "Dominguez-Rodriguez" "email" => array:1 [ 0 => "adrvdg@hotmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Nestor" "apellidos" => "Baez-Ferrer" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Pedro" "apellidos" => "Abreu-Gonzalez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Hospital Universitario de Canarias, Department of Cardiology, Tenerife, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Facultad de Ciencias de La Salud, Universidad Europea de Canarias, Tenerife, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Ciencias Médicas Básicas (Unidad de Fisiología), Universidad de La Laguna, Tenerife, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Impacto clínico del test de ejercicio cardiopulmonar en la miocardiopatía hipertrófica" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Santos-Mateo et al. perform an update on hypertrophic cardiomyopathy (HCM) very interesting.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> However, we would like to point out an important aspect about of the dynamic evaluation of patients with hypertrophic cardiomyopathy and the cardiopulmonary exercise testing (CPET), a diagnostic tool which from our point of view, should not be forgotten.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">CPET is an established clinical tool used in the management of a variety of cardiac disorders.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> In patients with congestive heart failure, metabolic parameters such as peak myocardial oxygen consumption with maximal exercise identifies high-risk individuals requiring close monitoring as potential heart transplant candidates, and also with the potential of differentiating cardiac from pulmonary dyspnea.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In HCM, numerous cross-sectional studies have demonstrated that peak myocardial oxygen consumption correlates with a number of clinically relevant variables, including severity of diastolic function, quality of life, and (inversely) with outflow tract gradient.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Also, intervention with myectomy or alcohol ablation to relieve outflow obstruction, a major determinant of heart failure symptoms in HCM, is associated with improved peak myocardial oxygen consumption.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Furthermore, there are now substantial published reports relating CPET data to outcome in >3000 HCM patients reported from several major centers.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Recent European Society of Cardiology (ESC) treatment guidelines for HCM recommend that CPET be considered for all HCM patients undergoing invasive septal reduction therapy to assess severity of symptom limitation.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> However, a challenge remains in translating these broad ESC recommendations for CPET to guide management in different subgroups within the diverse HCM patient population.</p><p id="par0025" class="elsevierStylePara elsevierViewall">CPET maximum peak oxygen consumption can be useful in distinguishing HCM with relatively mild left ventricular hypertrophy from physiological hypertrophy (i.e., athlete's heart).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> For individual athlete-patients within an ambiguous diagnostic “grey zone,” based on conventional imaging markers, a peak oxygen consumption >50<span class="elsevierStyleHsp" style=""></span>ml/kg/min (or >20% above the predicted maximum) is most consistent with athlete's heart and is nondiagnostic of HCM.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion, CPET can provide a quantitative assessment of functional limitation, with peak oxygen consumption a potential predictor and arbitrator for therapeutic decision-making in symptomatic patients with and without obstruction. Therefore, in this review,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> the omission of this technique could deprive at the medical community of potentially useful information and relevant in the current contemporary treatment era for this complex genetic disease.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypertrophic cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.J. Santos Mateo" 1 => "M. Sabater Molina" 2 => "J.R. Gimeno Blanes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2018" "volumen" => "150" "paginaInicial" => "434" "paginaFinal" => "442" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Role of exercise testing in hypertrophic cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E.J. Rowin" 1 => "B.J. Maron" 2 => "I. Olivotto" 3 => "M.S. Maron" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcmg.2017.07.016" "Revista" => array:6 [ "tituloSerie" => "JACC Cardiovasc Imaging" "fecha" => "2017" "volumen" => "10" "paginaInicial" => "1374" "paginaFinal" => "1386" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29122139" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiopulmonary exercise testing: what is its value?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Guazzi" 1 => "F. Bandera" 2 => "C. Ozemek" 3 => "D. Systrom" 4 => "R. 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Charron" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehu284" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2014" "volumen" => "35" "paginaInicial" => "2733" "paginaFinal" => "2779" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25173338" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015200000003/v1_201901290746/S2387020618305485/v1_201901290746/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015200000003/v1_201901290746/S2387020618305485/v1_201901290746/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020618305485?idApp=UINPBA00004N" ]
Journal Information
Vol. 152. Issue 3.
Pages e15 (February 2019)
Vol. 152. Issue 3.
Pages e15 (February 2019)
Letter to the Editor
Clinical impact of cardiopulmonary exercise testing in hypertrophic cardiomyopathy
Impacto clínico del test de ejercicio cardiopulmonar en la miocardiopatía hipertrófica
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