Key result
Peak VO2% <60% linked to ~461% higher MACE risk in HCM patients.
Why the study?
The role of cardiopulmonary exercise testing in predicting major adverse cardiac events in hypertrophic cardiomyopathy remains incompletely understood, particularly over long-term follow-up and independently of baseline symptoms.
Does a reduced percentage predicted peak VO2 (<60%) on cardiopulmonary exercise testing predict long-term major adverse cardiac events in patients with hypertrophic cardiomyopathy?
Does a reduced percentage predicted peak VO2 (<60%) on cardiopulmonary exercise testing predict long-term major adverse cardiac events in patients with hypertrophic cardiomyopathy?
Cardiopulmonary exercise testing is a powerful long-term prognostic tool in hypertrophic cardiomyopathy, where a peak VO2 <60% predicted identifies high-risk patients even when they are asymptomatic.
pVO₂% <60% was associated with higher long-term MACE risk in HCM; extends prior observational data but leaves open prospective validation.
Aims Hypertrophic cardiomyopathy (HCM) is a heterogeneous myocardial disorder characterized by left ventricular (LV) hypertrophy. The role of cardiopulmonary exercise testing (CPET) in predicting major adverse cardiac events (MACE) remains incompletely understood, particularly over long-term follow-up and independently of baseline symptoms. Methods and Results We longitudinally studied 154 HCM patients (age 43±16 years; 27% female), who underwent symptom-limited CPET. At baseline, 98 patients were in NYHA class I, 48 in class II, and 8 in class III. Septal reduction therapies (SRT), progression to end-stage HCM (ES-HCM), sudden cardiac death (SCD), heart failure-related death (HF), and heart transplantation (HT) represented a composite MACE endpoint. Over a mean follow-up of 12±9 years, 38 patients experienced MACE (SRT=9; ES-HCM=11; SCD=10; HF/HT=8). In multivariable analysis, independent predictors of MACE were percentage predicted peak VO₂ (pVO₂%) <60 (HR 4.16, 95%CI 1.89–9.14; p <0.001), and NYHA class >I (HR 2.27, 95%CI 1.06–4.89; p=0.036). By using SRT as a competing risk, the only predictor of MACE became pVO₂% <60 (HR: 3.966, 95%CI 1.626-9.670; p=0.002). Among asymptomatic patients (i.e. NYHA class I), only pVO₂% <60 remained a significant predictor of MACE (HR 5.611, 95%CI 1.635-19.253; p 0.006), with risk divergence evident after nearly 15 years of follow-up. The result was also confirmed in the competing risk analysis. Conclusions In this long follow-up study, CPET is a powerful prognostic tool in HCM. A reduced peak VO₂ identifies those at higher risk, highlighting the potential for CPET to improve risk stratification, even among patients classified as NYHA class I.
No takes yet. Share an insight, caveat, or question.
Ordine et al. (2026) studied this question. A peak VO₂% <60% identified patients with hypertrophic cardiomyopathy at significantly higher risk for major adverse cardiac events (HR 5.611) over a mean follow-up of 12 years.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: