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Background Patients with hypertrophic cardiomyopathy (HCM) sometimes display characteristic electrocardiographic (ECG) findings at rest and develop subendocardial ischemia during exercise in the absence of coronary lesions. However, their relationship has not yet been fully clarified. Methods Exercise Tc-99m-tetrofosmin myocardial scintigraphy was performed in 48 patients with non-obstructive HCM. We quantified transient left ventricular cavity dilation (LVCD) on exercise scintigrams, a parameter of subendocardial ischemia, and correlated the results with the ECG findings at rest and during exercise. Results Transient LVCD occurred during exercise in 17 (35%) patients with HCM. Hemodynamic parameters during exercise did not differ between HCM patients with and without transient LVCD. Multiple logistic regression analysis showed that transient LVCD was significantly associated with ST-segment depression at rest ( χ 2 =5.00, odds ratio=5.70, 95% confidence intervals 1.24–26.18, P =0.025) and a greater total number of leads with resting ST-segment depression ( χ 2 =6.38, odds ratio=1.60, 95% confidence intervals 1.12–2.42, P =0.012). The degree of LVCD was correlated with the total number of leads with ST-segment depression at rest ( P =0.002); the optimal cutoff for the diagnosis of transient LVCD was 3 with a sensitivity of 65%, a specificity of 90%, and an accuracy of 81%. Conclusions In patients with HCM, ST-segment depression at rest was accompanied by exercise-induced subendocardial perfusion abnormality as detected by myocardial scintigraphy. ST-segment depression at rest suggests that the subendocardium is predisposed to exertional ischemia.

OBJECTIVES This study was designed to assess the clinical usefulness of an exaggerated blood pressure (BP) response to exercise (EBPR) in predicting the development of hypertension from a high-normal state. BACKGROUND Exaggerated BP response during both dynamic and isometric exercises are associated with increased risk of future hypertension, while the significance of these responses concerning the identification of individuals with high-normal BP who are prone to develop hypertension is unknown. METHODS The study population comprised a sample of 239 men with high-normal BP (aged 42.3 ± 5.9 years) who underwent a symptom-limited bicycle ergometer exercise testing at baseline and then were followed for 5.1 years. RESULTS The Kaplan-Meier survival analysis showed that the subjects in the upper quartile of BP response to exercise had a significantly higher cumulative incidence of hypertension on follow-up than those in the middle two and lower quartiles (log-rank test, p CONCLUSIONS These findings suggest that an EBPR is an important risk factor for new-onset hypertension from a high-normal state and, thus, exercise testing can provide valid information that may help identify individuals with high-normal BP at a greater risk of future hypertension.

Edge Dissection by OCT (n1⁄419) Non-Edge Dissection by OCT (n1⁄438) Angiography Edge dissection (+) 1 (1.8%) 2 Edge dissection (-) 18 36 IVUS Edge dissection (+) 3 (5.3%) 0 Edge dissection (-) 16 38 Conclusion: OCT is superior to conventional coronary angiography and IVUS in the identification of stent ED. The risk of ED may be reduced if underlying plaque composition is considered when assessing stent length thereby ensuring that stent landing zones are free of calcium and necrotic core.