Biphasic force-frequency relation predicts primary cardiac events in patients with hypertrophic cardiomyopathy

Ryota Morimoto, Takahiro Okumura, Yasuko K. Bando, Kenji Fukaya, Akinori Sawamura, Haruya Kawase, Shinya Shimizu, Shuzo Shimazu, Akihiro Hirashiki, Kyosuke Takeshita, Toyoaki Murohara

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2 Citations (Scopus)


Background: The force-frequency relation (FFR) is a hemodynamic index of the chronotropic relationship between left ventricular (LV) systolic function (percent change in dP/dtmax) and elevation of heart rate. FFR is a marker of myocardial contractile reserve and follows an upward slope in healthy myocardium [monophasic FFR (MoF)], a pattern that becomes biphasic (BiF) under pathological conditions. However, it remains uncertain whether the FFR determines a patient’s prognosis. We investigated the promising role of the FFR as a predictor of cardiac events in the setting of hypertrophic cardiomyopathy (HCM). Methods and Results: A total of 113 consecutive patients with HCM (New York Heart Association (NYHA) class I–II) were retrospectively evaluated; 27 (23.9%) had a BiF pattern and they experienced a higher incidence of cardiac events compared with those showing an MoF pattern (median follow-up, 4.7 years; P<0.001). Furthermore, Cox proportional hazard regression analysis revealed that the LV end-diastolic volume index (hazard ratio: 1.051, P=0.014) and BiF pattern (hazard ratio: 15.260, P=0.001) were independent predictors of primary cardiac events. Interestingly, abnormal reductions in myocardial regulatory molecules related to contractility (SERCA2α) were observed exclusively in the patients exhibiting a BiF pattern. Conclusions: The FFR reflects latent myocardial abnormalities and predicts cardiac events in the setting of HCM, even during the asymptomatic stages of the disease.

Original languageEnglish
Pages (from-to)368-375
Number of pages8
JournalCirculation Journal
Issue number3
Publication statusPublished - 2017

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine


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