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Determinants of peak oxygen uptake in patients with hypertrophic cardiomyopathy: a single-center study

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Abstract

Most patients with hypertrophic cardiomyopathy (HCM) usually complain of a reduced exercise capacity, and several factors have been advocated as possible causes of this clinical feature. The present single-center study was designed to investigate exercise capacity and its main clinical determinants in HCM patients. One hundred ninety seven patients of 223 evaluated underwent a complete clinical assessment, including Doppler echocardiography, cardiopulmonary exercise test (CPET) and, in most cases, cardiac magnetic resonance. The HCM population (male 75 %; age 47 ± 16 years; NYHA class I or II 95 %; left ventricular ejection fraction 61 ± 3 %; resting left ventricular outflow tract gradient ≥30 mmHg 22 %; late gadolinium enhancement presence 58 %) showed slightly reduced mean peak oxygen uptake values (pVO2 75 ± 15 %, 23.2 ± 6.7 ml/kg/min) with a significant reduction of the achieved percentage of peak heart rate reserve (%pHRR 65 ± 20 %). Adopting a pVO2 <80 % cut-off value, 59 % of HCM patients showed a reduced exercise capacity. Age, male gender, left atrial size, chronotropic and systolic blood pressure response, ventilatory efficiency, late gadolinium enhancement presence and β-blocker therapy were independently associated with pVO2 (R 2-adjusted index 0.738). A %pHRR cut-off value of 74 % appeared to most accurately predict an impaired exercise capacity (area under curve 0.90). A great prevalence of reduced exercise capacity is present in NYHA class I–II HCM patients. Notwithstanding its multifactorial genesis, few parameters might be adopted in identifying this feature. In this context, %pHRR value might represent a reliable and easy-to-obtain tool for the clinical evaluation of HCM patients.

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Authors and Affiliations

  1. Cardiology Unit, Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy

    Damiano Magrì, Filippo Maria Cauti, Beatrice Musumeci, Gabriele Egidy Assenza, Agnese Ricotta, Erika Pagannone, Laura Marino, Daria Santini, Giulia Proietti, Andrea Serdoz, Francesco Paneni, Massimo Volpe & Camillo Autore

  2. Centro Cardiologico Monzino IRCCS, University of Milan, via Parea 4, 20138, Milan, Italy

    Piergiuseppe Agostoni

  3. Division of Critical Care and Respiratory Medicine, University of Washington, Seattle, WA, USA

    Piergiuseppe Agostoni

  4. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

    Piergiuseppe Agostoni

  5. Department of Cardiology, Boston Adult Congenital Heart Disease and Pulmonary Hypertension Program, Children’s Hospital Boston and Brigham and Women’s Hospital, Boston, MA, USA

    Gabriele Egidy Assenza

  6. Department of Radiological Sciences, Sapienza University, Rome, Italy

    Carlo Nicola De Cecco & Giuseppe Muscogiuri

  7. Department of Public Institutions, Economy and Society, University “Roma Tre”, Rome, Italy

    Antonello Maruotti

  8. Southampton Statistical Sciences Research Institute and School of Mathematics, University of Southampton, Southampton, UK

    Antonello Maruotti

  9. IRCCS Neuromed, Pozzilli, IS, Italy

    Francesco Paneni & Massimo Volpe

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  1. Damiano Magrì
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Correspondence to Piergiuseppe Agostoni.

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Magrì, D., Agostoni, P., Cauti, F.M. et al. Determinants of peak oxygen uptake in patients with hypertrophic cardiomyopathy: a single-center study. Intern Emerg Med 9, 293–302 (2014). https://doi.org/10.1007/s11739-012-0866-x

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