Heart failure & cardiomyopathies
Severe left ventricular outflow tract (LVOT) obstruction in hypertrophic cardiomyopathy (HCM): effects on exercise capacity and outcomes from cardiopulmonary exercise testing combined with stress echocardiography
- retrospective analysis
- combined cardiopulmonary exercise testing and stress echocardiography (TTE-CPET)
+1 more
- combined cardiopulmonary exercise testing and stress echocardiography (TTE-CPET)
Authors' conclusion
Severe dynamic LVOT obstruction identifies a high-risk HCM subgroup with impaired exercise capacity and poor prognosis. Intermediate gradients may still warrant close monitoring. TTE-CPET offers critical insight for risk stratification and early intervention.
Study context
- Population
- HCM patients undergoing TTE-CPETHCM patients undergoing TTE-CPET
- Participants
- 388 patients
- Exposure
- four groups based on peak LVOT gradient
- ≥80 mmHgn = 82
- Outcome
- Composite of:
- NYHA class worsening
- Heart failure hospitalization
- New-onset atrial fibrillation
- Progression to end-stage HCM
- Follow-up
- Median 7.4 years
Main finding
As reported in the abstract
Composite of:
- NYHA class worsening
- Heart failure hospitalization
- New-onset atrial fibrillation
- Progression to end-stage HCM
- higher with severe obstruction; comparator not named
- incidence of adverse events 50.0% vs. 31.6%; P = 0.011
- independently predicted adverse outcomes, even after adjustment; comparator not named
- HR 1.87; P = 0.009
Observational data: associations, not effects.
Further findings
| Outcome | peak VO2 (mL/kg/min) | P value |
|---|---|---|
| Peak VO2 | 15.9 vs. 19.7 | P = 0.003 |
- Peak VO2: significantly lower with severe obstruction; comparator not named
Peak VO2
- Severe obstruction: higher pulmonary pressures, more advanced diastolic dysfunction, and greater symptom burden
Intermediate gradients (30-79 mmHg)
- generally preserved outcomes, though some exhibited early structural or functional changes
Original publication
Severe LVOT obstruction in HCM: effects on exercise capacity and outcomes from cardiopulmonary exercise testing combined with stress echocardiography. Eur Heart J Qual Care Clin Outcomes. Published 6 April 2026. doi:10.1093/ehjqcco/qcag056
Summarised from the published abstract; every number is checked against it