Heart failure & cardiomyopathies
Exercise Limitation in Hypertrophic Cardiomyopathy: Combined Stress Echocardiography and Cardiopulmonary Exercise Test
Authors' conclusion
Both central and peripheral cardiovascular limitations are involved in exercise intolerance in HCM. Diastolic dysfunction seems to be the main driver for this limitation.
Study context
- Population
- Hypertrophic cardiomyopathy (HCM) patients (mean age 67 ± 6 years, 72% men)matched controls
- Participants
- 36 vs 29
- Comparison
- HCM vs matched controls
- HCMn = 36
- Controlsn = 29reference
- Outcome
- Exercise-limiting factors on symptom-limited semi-supine ramp bicycle test
Methodological detailscombined stress echocardiography and cardiopulmonary exercise test, age and sex-matched controls, Oxygen extraction calculated by Fick equation; echo images obtained concurrently with gas exchange at predefined stages
- Combined stress echocardiography and cardiopulmonary exercise test
- Age and sex-matched controls
- Oxygen extraction calculated by Fick equation; echo images obtained concurrently with gas exchange at predefined stages
Main finding
As reported in the abstract
Oxygen consumption (reduced in HCM) · peak exercise
- HCM vs Controls: P = 0.01
- Unloaded: 6.6 ± 1.7 vs. 6.8 ± 1.6, P = 0.86
- Anaerobic threshold: 18.1 ± 2.2 vs. 14.6 ± 1.5, P = 0.008
Further findings
SPAP at rest
P = 0.023
| Outcome | HCM | Controls | P value |
|---|---|---|---|
| E/E' ratio at rest | mean 14 ± 2.5 | mean 6.26 ± 2.3 | P < 0.001 |
- E/e' (diastolic function worsened in HCM) · peak exercise
- P < 0.001
- Systolic pulmonary artery pressures (SPAP) during exercise · peak exercise
- P < 0.001
- Oxygen pulse (blunted in HCM) · peak exercise
- P = 0.002
- Stroke volume · peak exercise
- P = 0.034
- Oxygen extraction · peak exercise
- P = 0.03
- E/e' (diastolic function worsened in HCM): unloaded: 8.9 ± 2.6 vs. 13.8 ± 3.6 P = 0.011
- E/e' (diastolic function worsened in HCM): anaerobic threshold: 9.4 ± 2.3 vs. 18.6 ± 3.3 P = 0.001
- SPAP during exercise: unloaded: 23 ± 2.7 vs. 33 ± 4.4, P = 0.013
- SPAP during exercise: anaerobic threshold: 26 ± 3.2 vs. 40 ± 2.9, P < 0.001
- Oxygen pulse (blunted in HCM): unloaded: 6.3 ± 1.8 vs. 6.2 ± 1.9, P = 0.79
- Oxygen pulse (blunted in HCM): anaerobic threshold: 10 ± 2.1 vs. 8.8 ± 1.6, P = 0.063
- Stroke volume: unloaded: 92.3 ± 17 vs. 77.3 ± 14.5 P = 0.021
- Stroke volume: anaerobic threshold: 101 ± 19.1 vs. 87.3 ± 15.7 P = 0.06
- Oxygen extraction: unloaded: 0.07 ± 0.03 vs. 0.07 ± 0.02, P = 0.47
- Oxygen extraction: anaerobic threshold: 0.13 ± 0.02 vs. 0.10 ± 0.03, P = 0.013
Determinants of exercise capacity
- Diastolic dysfunction, elevated SPAP and AF associated with reduced exercise capacity
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Exercise Limitation in Hypertrophic Cardiomyopathy: Combined Stress Echocardiography and Cardiopulmonary Exercise Test. ESC Heart Fail. Published 18 April 2024. doi:10.
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