Skip to main content
Top
Published in: Trials 1/2008

Open Access 01-12-2008 | Research

Echocardiographic predictors of severe heart failure symptoms in hypertrophic cardiomyopathy patients with sinus rhythm

Authors: Fatih Bayrak, Gokhan Kahveci, Muzaffer Degertekin, Bulent Mutlu

Published in: Trials | Issue 1/2008

Login to get access

Abstract

Background

Symptoms in hypertrophic cardiomyopathy (HC) appear to be caused by diastolic dysfunction, myocardial ischemia, left ventricle (LV) outflow obstruction, and atrial fibrillation. However, clinical deterioration and severe heart failure symptoms can be observed in patients without any of these factors. Thus, the aim of this study is to determine the echocardiographic predictors of severe heart failure symptoms in patients with HC.

Methods and results

86 HC patients were compared according to symptomatic status. Patients with severe heart failure symptoms were older, preponderantly female, had more often LV outflow obstruction and mitral regurgitation, longer E wave deceleration time (EDt), higher E/Ea ratios and lower LV tissue Doppler (TD) velocities when compared to rest of the patients. LV outflow obstruction (r = 0.43, R2 = 0.19, p < 0.0001), LV lateral mitral annular systolic TD velocity (LMSa) (r = 0.51, R2 = 0.26, p < 0.006) and EDt (r = 0.55, R2 = 0.30, p < 0.027) were found to be the independent predictors for severe heart failure symptoms in forward stepwise regression.

Conclusion

In HCM patients with sinus rhythm and normal LV systolic function, LMSa, EDt and LV outflow obstruction are independent predictors of heart failure symptoms. Diastolic dysfunction determined with EDt, occult systolic dysfunction which is detected with TD analysis, and afterload increase as result of LV outflow obstruction seem to be the main echocardiographic factors affecting symptomatic status in HCM patients with sinus rhythm and normal systolic function.
Appendix
Available only for authorised users
Literature
1.
go back to reference Maron BJ, McKenna WJ, Danielson GK, Kappenberger LJ, Kuhn HJ, Seidman CE, Shah PM, Spencer WH, Spirito P, Ten Cate FJ, Wigle ED, Task Force on Clinical Expert Consensus Documents: ACC/ESC Clinical expert document on hypertophic cardiomyopathy: a report of American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and European Society of Cardiology Committee for Practice Guidelines. J Am Coll Cardiol. 2003, 42: 1687-1713. 10.1016/S0735-1097(03)00941-0.CrossRefPubMed Maron BJ, McKenna WJ, Danielson GK, Kappenberger LJ, Kuhn HJ, Seidman CE, Shah PM, Spencer WH, Spirito P, Ten Cate FJ, Wigle ED, Task Force on Clinical Expert Consensus Documents: ACC/ESC Clinical expert document on hypertophic cardiomyopathy: a report of American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and European Society of Cardiology Committee for Practice Guidelines. J Am Coll Cardiol. 2003, 42: 1687-1713. 10.1016/S0735-1097(03)00941-0.CrossRefPubMed
2.
go back to reference Maron BJ: Hypertrophic cardiomyopathy: a systematic review. JAMA. 2002, 287: 1308-1320. 10.1001/jama.287.10.1308.PubMed Maron BJ: Hypertrophic cardiomyopathy: a systematic review. JAMA. 2002, 287: 1308-1320. 10.1001/jama.287.10.1308.PubMed
3.
go back to reference Klues HG, Schiffers A, Maron BJ: Phenotypic spectrum and patterns of left ventricular hypertrophy in hypertrophic cardiomyopathy: morphologic observations and significance as assessed by two dimensional echocardiography in 600 patients. J Am Coll Cardiol. 1995, 26: 1699-1708. 10.1016/0735-1097(95)00390-8.CrossRefPubMed Klues HG, Schiffers A, Maron BJ: Phenotypic spectrum and patterns of left ventricular hypertrophy in hypertrophic cardiomyopathy: morphologic observations and significance as assessed by two dimensional echocardiography in 600 patients. J Am Coll Cardiol. 1995, 26: 1699-1708. 10.1016/0735-1097(95)00390-8.CrossRefPubMed
4.
go back to reference Frenneaux MP, Porter A, Caforio AL, Odawara H, Counihan PJ, McKenna WJ: Determinants of exercise capacity in hypertrophic cardiomyopathy. J Am Coll Cardiol. 1989, 13: 1521-1526.CrossRefPubMed Frenneaux MP, Porter A, Caforio AL, Odawara H, Counihan PJ, McKenna WJ: Determinants of exercise capacity in hypertrophic cardiomyopathy. J Am Coll Cardiol. 1989, 13: 1521-1526.CrossRefPubMed
5.
go back to reference Briguori C, Betocchi S, Romano M, Manganelli F, Angela Losi M, Ciampi Q, Gottilla R, Lombardi R, Condorelli M, Chiariello M: Exercise capacity in hypertrophic cardiomyopathy depends on left ventricular diastolic function. Am J Cardiol. 1999, 84: 309-315. 10.1016/S0002-9149(99)00282-9.CrossRefPubMed Briguori C, Betocchi S, Romano M, Manganelli F, Angela Losi M, Ciampi Q, Gottilla R, Lombardi R, Condorelli M, Chiariello M: Exercise capacity in hypertrophic cardiomyopathy depends on left ventricular diastolic function. Am J Cardiol. 1999, 84: 309-315. 10.1016/S0002-9149(99)00282-9.CrossRefPubMed
6.
go back to reference Lele SS, Thomson HL, Seo H, Belenkie I, McKenna WJ, Frenneaux MP: Exercise capacity in hypertrophic cardiomyopathy. Role of stroke volume limitation, heart rate, and diastolic filling characteristics. Circulation. 1995, 92: 2886-2894.CrossRefPubMed Lele SS, Thomson HL, Seo H, Belenkie I, McKenna WJ, Frenneaux MP: Exercise capacity in hypertrophic cardiomyopathy. Role of stroke volume limitation, heart rate, and diastolic filling characteristics. Circulation. 1995, 92: 2886-2894.CrossRefPubMed
7.
go back to reference Spirito P, Maron BJ, Bonow RO, Epstein SE: Severe functional limitation in patients with hypertrophic cardiomyopathy and only mild localized left ventricular hypertrophy. J Am Coll Cardiol. 1986, 8: 537-544.CrossRefPubMed Spirito P, Maron BJ, Bonow RO, Epstein SE: Severe functional limitation in patients with hypertrophic cardiomyopathy and only mild localized left ventricular hypertrophy. J Am Coll Cardiol. 1986, 8: 537-544.CrossRefPubMed
8.
go back to reference Spirito P, Maron BJ: Relation between extent of left ventricular hypertrophy and diastolic filling abnormalities in hypertrophic cardiomyopathy. J Am Coll Cardiol. 1990, 15: 808-813.CrossRefPubMed Spirito P, Maron BJ: Relation between extent of left ventricular hypertrophy and diastolic filling abnormalities in hypertrophic cardiomyopathy. J Am Coll Cardiol. 1990, 15: 808-813.CrossRefPubMed
9.
go back to reference Cecchi F, Olivotto I, Gistri R, Lorenzoni R, Chiriatti G, Camici PG: Coronary microvascular dysfunction and prognosis in hypertrophic cardiomyopathy. N Engl J Med. 2003, 349: 1027-1035. 10.1056/NEJMoa025050.CrossRefPubMed Cecchi F, Olivotto I, Gistri R, Lorenzoni R, Chiriatti G, Camici PG: Coronary microvascular dysfunction and prognosis in hypertrophic cardiomyopathy. N Engl J Med. 2003, 349: 1027-1035. 10.1056/NEJMoa025050.CrossRefPubMed
10.
go back to reference Grover-McKay M, Schwaiger M, Krivokapich J, Perloff JK, Phelps ME, Schelbert HR: Regional myocardial blood flow and metabolism at rest in mildly symptomatic patients with hypertrophic cardiomyopathy. J Am Coll Cardiol. 1989, 13: 317-324.CrossRefPubMed Grover-McKay M, Schwaiger M, Krivokapich J, Perloff JK, Phelps ME, Schelbert HR: Regional myocardial blood flow and metabolism at rest in mildly symptomatic patients with hypertrophic cardiomyopathy. J Am Coll Cardiol. 1989, 13: 317-324.CrossRefPubMed
11.
go back to reference Krams R, Kofflard MJ, Duncker DJ, Von Birgelen C, Carlier S, Kliffen M, Ten Cate FJ, Serruys PW: Decreased coronary flow reserve in hypertrophic cardiomyopathy is related to remodeling of the coronary microcirculation. Circulation. 1998, 97: 230-233.CrossRefPubMed Krams R, Kofflard MJ, Duncker DJ, Von Birgelen C, Carlier S, Kliffen M, Ten Cate FJ, Serruys PW: Decreased coronary flow reserve in hypertrophic cardiomyopathy is related to remodeling of the coronary microcirculation. Circulation. 1998, 97: 230-233.CrossRefPubMed
12.
go back to reference Nienaber CA, Gambhir SS, Mody FV, Ratib O, Huang SC, Phelps ME, Schelbert HR: Regional myocardial blood flow and glucose utilization in symptomatic patients with hypertrophic cardiomyopathy. Circulation. 1993, 87: 1580-1590.CrossRefPubMed Nienaber CA, Gambhir SS, Mody FV, Ratib O, Huang SC, Phelps ME, Schelbert HR: Regional myocardial blood flow and glucose utilization in symptomatic patients with hypertrophic cardiomyopathy. Circulation. 1993, 87: 1580-1590.CrossRefPubMed
13.
go back to reference O'Gara PT, Bonow RO, Maron BJ, Damske BA, Van Lingen A, Bacharach SL, Larson SM, Epstein SE: Myocardial perfusion abnormalities in patients with hypertrophic cardiomyopathy: assessment with thallium-201 emission computed tomography. Circulation. 1987, 76: 1214-1223.CrossRefPubMed O'Gara PT, Bonow RO, Maron BJ, Damske BA, Van Lingen A, Bacharach SL, Larson SM, Epstein SE: Myocardial perfusion abnormalities in patients with hypertrophic cardiomyopathy: assessment with thallium-201 emission computed tomography. Circulation. 1987, 76: 1214-1223.CrossRefPubMed
14.
go back to reference Takata J, Counihan PJ, Gane JN, Doi Y, Chikamori T, Ozawa T, McKenna WJ: Regional thallium-201 washout and myocardial hypertrophy in hypertrophic cardiomyopathy and its relation to exertional chest pain. Am J Cardiol. 1993, 72: 211-217. 10.1016/0002-9149(93)90162-6.CrossRefPubMed Takata J, Counihan PJ, Gane JN, Doi Y, Chikamori T, Ozawa T, McKenna WJ: Regional thallium-201 washout and myocardial hypertrophy in hypertrophic cardiomyopathy and its relation to exertional chest pain. Am J Cardiol. 1993, 72: 211-217. 10.1016/0002-9149(93)90162-6.CrossRefPubMed
15.
go back to reference Schwartzkopff B, Mundhenke M, Strauer BE: Alterations of the architecture of subendocardial arterioles in patients with hypertrophic cardiomyopathy and impaired coronary vasodilator reserve: a possible cause for myocardial ischemia. J Am Coll Cardiol. 1998, 31: 1089-1096. 10.1016/S0735-1097(98)00036-9.CrossRefPubMed Schwartzkopff B, Mundhenke M, Strauer BE: Alterations of the architecture of subendocardial arterioles in patients with hypertrophic cardiomyopathy and impaired coronary vasodilator reserve: a possible cause for myocardial ischemia. J Am Coll Cardiol. 1998, 31: 1089-1096. 10.1016/S0735-1097(98)00036-9.CrossRefPubMed
16.
go back to reference Wigle ED, Sasson Z, Henderson MA, Ruddy TD, Fulop J, Rakowski H, Williams WG: Hypertrophic cardiomyopathy. The importance of the site and the extent of hypertrophy. A review. Prog Cardiovasc Dis. 1985, 28: 1-83. 10.1016/0033-0620(85)90024-6.CrossRefPubMed Wigle ED, Sasson Z, Henderson MA, Ruddy TD, Fulop J, Rakowski H, Williams WG: Hypertrophic cardiomyopathy. The importance of the site and the extent of hypertrophy. A review. Prog Cardiovasc Dis. 1985, 28: 1-83. 10.1016/0033-0620(85)90024-6.CrossRefPubMed
17.
go back to reference Maron MS, Olivotto I, Betocchi S, Casey SA, Lesser JR, Losi MA, Cecchi F, Maron BJ: Effect of left ventricular outflow tract obstruction on clinical outcome in hypertrophic cardiomyopathy. N Engl J Med. 2003, 348: 295-303. 10.1056/NEJMoa021332.CrossRefPubMed Maron MS, Olivotto I, Betocchi S, Casey SA, Lesser JR, Losi MA, Cecchi F, Maron BJ: Effect of left ventricular outflow tract obstruction on clinical outcome in hypertrophic cardiomyopathy. N Engl J Med. 2003, 348: 295-303. 10.1056/NEJMoa021332.CrossRefPubMed
18.
go back to reference Olivotto I, Cecchi F, Casey SA, Dolara A, Traverse JH, Maron BJ: Impact of atrial fibrillation on the clinical course of hypertrophic cardiomyopathy. Circulation. 2001, 104: 2517-24. 10.1161/hc4601.097997.CrossRefPubMed Olivotto I, Cecchi F, Casey SA, Dolara A, Traverse JH, Maron BJ: Impact of atrial fibrillation on the clinical course of hypertrophic cardiomyopathy. Circulation. 2001, 104: 2517-24. 10.1161/hc4601.097997.CrossRefPubMed
19.
go back to reference Wigle ED, Rakowski H, Kimball BP, Williams WG: Hypertrophic cardiomyopathy: clinical spectrum and treatment. Circulation. 1995, 92: 1680-1692.CrossRefPubMed Wigle ED, Rakowski H, Kimball BP, Williams WG: Hypertrophic cardiomyopathy: clinical spectrum and treatment. Circulation. 1995, 92: 1680-1692.CrossRefPubMed
20.
go back to reference Maron BJ, Spirito P: Implications of left ventricular remodeling in hypertrophic cardiomyopathy. Am J Cardiol. 1998, 81: 1339-1344. 10.1016/S0002-9149(98)00164-7.CrossRefPubMed Maron BJ, Spirito P: Implications of left ventricular remodeling in hypertrophic cardiomyopathy. Am J Cardiol. 1998, 81: 1339-1344. 10.1016/S0002-9149(98)00164-7.CrossRefPubMed
21.
go back to reference Spirito P, Bellone P, Harris KM, Bernabo P, Bruzzi P, Maron BJ: Magnitude of left ventricular hypertrophy predicts the risk of sudden death in hypertrophic cardiomyopathy. N Engl J Med. 2000, 342: 1778-1785. 10.1056/NEJM200006153422403.CrossRefPubMed Spirito P, Bellone P, Harris KM, Bernabo P, Bruzzi P, Maron BJ: Magnitude of left ventricular hypertrophy predicts the risk of sudden death in hypertrophic cardiomyopathy. N Engl J Med. 2000, 342: 1778-1785. 10.1056/NEJM200006153422403.CrossRefPubMed
22.
go back to reference Ikeda H, Maki S, Yoshida N, Murohara T, Adachi H, Koga Y, Imaizumi T: Predictors of death from congestive cardiac failure in hypertrophic cardiomyopathy. Am J Cardiol. 1999, 83: 1280-1283. 10.1016/S0002-9149(99)00075-2.CrossRefPubMed Ikeda H, Maki S, Yoshida N, Murohara T, Adachi H, Koga Y, Imaizumi T: Predictors of death from congestive cardiac failure in hypertrophic cardiomyopathy. Am J Cardiol. 1999, 83: 1280-1283. 10.1016/S0002-9149(99)00075-2.CrossRefPubMed
23.
go back to reference Nagueh SF, Bachinski LL, Meyer D, Hill R, Zoghbi WA, Tam JW, Quiñones MA, Roberts R, Marian AJ: Tissue Doppler imaging consistently detects myocardial abnormalities in patients with hypertrophic cardiomyopathy and provides a novel means for an early diagnosis before and independently of hypertrophy. Circulation. 2001, 104: 128-130.CrossRefPubMedPubMedCentral Nagueh SF, Bachinski LL, Meyer D, Hill R, Zoghbi WA, Tam JW, Quiñones MA, Roberts R, Marian AJ: Tissue Doppler imaging consistently detects myocardial abnormalities in patients with hypertrophic cardiomyopathy and provides a novel means for an early diagnosis before and independently of hypertrophy. Circulation. 2001, 104: 128-130.CrossRefPubMedPubMedCentral
24.
go back to reference Helmcke F, Nanda NC, Hsiung MC, Soto B, Adey CK, Goyal RG, Gatewood RP: Color Doppler assessment of mitral regurgitation with orthogonal planes. Circulation. 1987, 75: 175-183.CrossRefPubMed Helmcke F, Nanda NC, Hsiung MC, Soto B, Adey CK, Goyal RG, Gatewood RP: Color Doppler assessment of mitral regurgitation with orthogonal planes. Circulation. 1987, 75: 175-183.CrossRefPubMed
25.
go back to reference Patel R, Nagueh SF, Tsybouleva N, Abdellatif M, Lutucuta S, Kopelen HA, Quinones MA, Zoghbi WA, Entman ML, Roberts R, Marian AJ: Simvastatin induces regression of cardiac hypertrophy and fibrosis and improves cardiac function in a transgenic rabbit model of human hypertrophic cardiomyopathy. Circulation. 2001, 104: 317-324. 10.1161/hc2801.094031.CrossRefPubMedPubMedCentral Patel R, Nagueh SF, Tsybouleva N, Abdellatif M, Lutucuta S, Kopelen HA, Quinones MA, Zoghbi WA, Entman ML, Roberts R, Marian AJ: Simvastatin induces regression of cardiac hypertrophy and fibrosis and improves cardiac function in a transgenic rabbit model of human hypertrophic cardiomyopathy. Circulation. 2001, 104: 317-324. 10.1161/hc2801.094031.CrossRefPubMedPubMedCentral
26.
go back to reference Chikamori T, Counihan PJ, Doi YL, Takata J, Stewart JT, Frenneaux MP, McKenna WJ: Mechanisms of exercise limitation in hypertrophic cardiomyopathy. J Am Coll Cardiol. 1992, 19: 507-512.CrossRefPubMed Chikamori T, Counihan PJ, Doi YL, Takata J, Stewart JT, Frenneaux MP, McKenna WJ: Mechanisms of exercise limitation in hypertrophic cardiomyopathy. J Am Coll Cardiol. 1992, 19: 507-512.CrossRefPubMed
27.
go back to reference Nishimura RA, Appleton CP, Redfield MM, Ilstrup DM, Holmes DR, Tajik AJ: Noninvasive Doppler echocardiographic evaluation of left ventricular filling pressures in patients with cardiomyopathies: a simultaneous Doppler echocardiographic and cardiac catheterization study. J Am Coll Cardiol. 1996, 28: 1226-1233. 10.1016/S0735-1097(96)00315-4.CrossRefPubMed Nishimura RA, Appleton CP, Redfield MM, Ilstrup DM, Holmes DR, Tajik AJ: Noninvasive Doppler echocardiographic evaluation of left ventricular filling pressures in patients with cardiomyopathies: a simultaneous Doppler echocardiographic and cardiac catheterization study. J Am Coll Cardiol. 1996, 28: 1226-1233. 10.1016/S0735-1097(96)00315-4.CrossRefPubMed
28.
go back to reference Nagueh SF, Lakkis NM, Middleton KJ, Spencer WH, Zoghbi WA, Quinones MA: Doppler estimation of left ventricular filling pressures in patients with hypertrophic cardiomyopathy. Circulation. 1999, 99: 254-261.CrossRefPubMed Nagueh SF, Lakkis NM, Middleton KJ, Spencer WH, Zoghbi WA, Quinones MA: Doppler estimation of left ventricular filling pressures in patients with hypertrophic cardiomyopathy. Circulation. 1999, 99: 254-261.CrossRefPubMed
29.
go back to reference Thomas JD, Weyman AE: Echo Doppler evaluation of left ventricular diastolic function: physics and physiology. Circulation. 1991, 84: 977-990.CrossRefPubMed Thomas JD, Weyman AE: Echo Doppler evaluation of left ventricular diastolic function: physics and physiology. Circulation. 1991, 84: 977-990.CrossRefPubMed
30.
go back to reference Choong CY, Herrmann HC, Weyman AE, Fifer MA: Preload dependence of Doppler-derived indices of left ventricular diastolic function in humans. J Am Coll Cardiol. 1987, 10: 800-818.CrossRefPubMed Choong CY, Herrmann HC, Weyman AE, Fifer MA: Preload dependence of Doppler-derived indices of left ventricular diastolic function in humans. J Am Coll Cardiol. 1987, 10: 800-818.CrossRefPubMed
31.
go back to reference Stoddard MF, Pearson AC, Kern MJ, Ratcliff J, Mrosek DG, Labovitz AJ: Influence of alteration in preload on the pattern of left ventricular diastolic filling assessed by Doppler echocardiography in humans. Circulation. 1989, 79: 1226-1236.CrossRefPubMed Stoddard MF, Pearson AC, Kern MJ, Ratcliff J, Mrosek DG, Labovitz AJ: Influence of alteration in preload on the pattern of left ventricular diastolic filling assessed by Doppler echocardiography in humans. Circulation. 1989, 79: 1226-1236.CrossRefPubMed
32.
go back to reference Ha JW, Cho JR, Kim JM, Ahn JA, Choi EY, Kang SM, Rim SJ, Chung N: Tissue Doppler-derived indices predict exercise capacity in patients with apical hypertrophic cardiomyopathy. Chest. 2005, 128: 3428-3433. 10.1378/chest.128.5.3428.CrossRefPubMed Ha JW, Cho JR, Kim JM, Ahn JA, Choi EY, Kang SM, Rim SJ, Chung N: Tissue Doppler-derived indices predict exercise capacity in patients with apical hypertrophic cardiomyopathy. Chest. 2005, 128: 3428-3433. 10.1378/chest.128.5.3428.CrossRefPubMed
33.
go back to reference Matsumura Y, Elliott PM, Virdee MS, Sorajja P, Doi Y, McKenna WJ: Left ventricular diastolic function assessed using Doppler tissue imaging in patients with hypertrophic cardiomyopathy: relation to symptoms and exercise capacity. Heart. 2002, 87: 247-251. 10.1136/heart.87.3.247.CrossRefPubMedPubMedCentral Matsumura Y, Elliott PM, Virdee MS, Sorajja P, Doi Y, McKenna WJ: Left ventricular diastolic function assessed using Doppler tissue imaging in patients with hypertrophic cardiomyopathy: relation to symptoms and exercise capacity. Heart. 2002, 87: 247-251. 10.1136/heart.87.3.247.CrossRefPubMedPubMedCentral
34.
go back to reference Cardim N, Torres D, Morais H, Candido A, Duarte R, Longo S, Ferreira T, Pereira A, Gouveia A, Reis RP, Correia JM: Tissue Doppler imaging in hypertrophic cardiomyopathy: impact of intraventricular obstruction on longitudinal left ventricular function. Rev Port Cardiol. 2002, 21: 271-297.PubMed Cardim N, Torres D, Morais H, Candido A, Duarte R, Longo S, Ferreira T, Pereira A, Gouveia A, Reis RP, Correia JM: Tissue Doppler imaging in hypertrophic cardiomyopathy: impact of intraventricular obstruction on longitudinal left ventricular function. Rev Port Cardiol. 2002, 21: 271-297.PubMed
35.
go back to reference Barac I, Upadya S, Pilchik R, Winson G, Passick M, Chaudhry FA, Sherrid MV: Effect of obstruction on longitudinal left ventricular shortening in hypertrophic cardiomyopathy. J Am Coll Cardiol. 2007, 49: 1203-1211. 10.1016/j.jacc.2006.10.070.CrossRefPubMed Barac I, Upadya S, Pilchik R, Winson G, Passick M, Chaudhry FA, Sherrid MV: Effect of obstruction on longitudinal left ventricular shortening in hypertrophic cardiomyopathy. J Am Coll Cardiol. 2007, 49: 1203-1211. 10.1016/j.jacc.2006.10.070.CrossRefPubMed
36.
go back to reference Sharma S, Elliott P, Whyte G, Jones S, Mahon N, Whipp B, McKenna WJ: Utility of cardiopulmonary exercise in the assessment of clinical determinants of functional capacity in hypertrophic cardiomyopathy. Am J Cardiol. 2000, 86: 162-168. 10.1016/S0002-9149(00)00854-7.CrossRefPubMed Sharma S, Elliott P, Whyte G, Jones S, Mahon N, Whipp B, McKenna WJ: Utility of cardiopulmonary exercise in the assessment of clinical determinants of functional capacity in hypertrophic cardiomyopathy. Am J Cardiol. 2000, 86: 162-168. 10.1016/S0002-9149(00)00854-7.CrossRefPubMed
Metadata
Title
Echocardiographic predictors of severe heart failure symptoms in hypertrophic cardiomyopathy patients with sinus rhythm
Authors
Fatih Bayrak
Gokhan Kahveci
Muzaffer Degertekin
Bulent Mutlu
Publication date
01-12-2008
Publisher
BioMed Central
Published in
Trials / Issue 1/2008
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/1745-6215-9-11

Other articles of this Issue 1/2008

Trials 1/2008 Go to the issue