What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertrophic cardiomyopathy (HCM) (n=388). Intervention: Severe LVOT obstruction (peak gradient ≥80 mmHg) vs. Non-severe LVOT obstruction (peak gradient <80 mmHg). Primary outcome: Composite of NYHA class worsening, heart failure hospitalization, new-onset atrial fibrillation, or progression to end-stage HCM (HR 1.87, p=0.009).

What question did this study set out to answer?

To assess how left ventricular outflow tract obstruction gradient severity influences exercise capacity and long-term clinical outcomes in hypertrophic cardiomyopathy.

April 10, 2026European Heart Journal - Quality of Care and Clinical Outcomes

Severe LVOT obstruction in HCM: effects on exercise capacity and outcomes from cardiopulmonary exercise testing combined with stress echocardiography

Q: What are the key findings of this study?

Severe dynamic LVOT obstruction (≥80 mmHg) independently predicted adverse outcomes in HCM patients compared to non-severe obstruction (50.0% vs. 31.6%; HR 1.87, P=0.009).

Q: What question did this study set out to answer?

To assess how left ventricular outflow tract obstruction gradient severity influences exercise capacity and long-term clinical outcomes in hypertrophic cardiomyopathy.

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Key result

, no (), no new claims.

HR 1.87
P=0.009
n=388

Why the study?

Does severe dynamic LVOT obstruction (≥80 mmHg) predict worse exercise capacity and clinical outcomes in patients with hypertrophic cardiomyopathy?

Population

Patients with HCM

Authors

RMRaffaella MistrulliOnze Lieve Vrouwziekenhuis Hospital FRFederica ReAzienda Ospedaliera San Camillo-Forlanini GGGuido GiacaloneSapienza University of Rome

Discussion

Member takes

Implication

May warrant early intervention in high-risk HCM; extends prognostic value of TTE-CPET.

Key Points

To assess how left ventricular outflow tract obstruction gradient severity influences exercise capacity and long-term clinical outcomes in hypertrophic cardiomyopathy.
Retrospective cohort analysis of 388 patients with hypertrophic cardiomyopathy evaluated using combined cardiopulmonary exercise testing and stress echocardiography.
Patients were stratified by peak left ventricular outflow tract gradient (<30, 30–49, 50–79, and ≥80 mmHg) and monitored over a median follow-up of 7.4 years for a composite adverse outcome.
Patients with severe obstruction (peak gradient ≥80 mmHg, n = 82) had significantly lower peak VO2 (15.9 vs. 19.7 mL/kg/min, P = 0.003), along with elevated pulmonary pressures and worse diastolic dysfunction.
Severe obstruction was associated with higher adverse event incidence (50.0% vs. 31.6%, P = 0.011) and was an independent predictor of adverse clinical outcomes (HR: 1.87, P = 0.009).

Study Design

Type

Cohort (n=388)

Structured PICO

Does severe dynamic LVOT obstruction (≥80 mmHg) predict worse exercise capacity and clinical outcomes in patients with hypertrophic cardiomyopathy?

Population

388 patients with hypertrophic cardiomyopathy undergoing combined cardiopulmonary exercise testing and stress echocardiography, followed for a median of 7.4 years.

Exposure

Severe dynamic left ventricular outflow tract (LVOT) obstruction (peak gradient ≥80 mmHg)

Comparator

Lower peak LVOT gradients (<30 mmHg, 30-49 mmHg, and 50-79 mmHg)

Outcome

Composite of NYHA class worsening, heart failure hospitalization, new-onset atrial fibrillation, or progression to end-stage HCM assessed over a median follow-up of 7.4 yearscomposite

Main Result

Hazard Ratio: 1.87

Absolute Event Rate: 50% vs 31.6%

p-value: p=0.009

Severe dynamic LVOT obstruction (≥80 mmHg) in HCM identifies a high-risk subgroup with impaired exercise capacity and worse long-term prognosis.

Cite This Study

Mistrulli et al. (2026) conducted a cohort in Hypertrophic cardiomyopathy (HCM) (n=388). Severe LVOT obstruction (peak gradient ≥80 mmHg) vs. Non-severe LVOT obstruction (peak gradient <80 mmHg) was evaluated on Composite of NYHA class worsening, heart failure hospitalization, new-onset atrial fibrillation, or progression to end-stage HCM (HR 1.87, p=0.009). Severe dynamic LVOT obstruction (≥80 mmHg) independently predicted adverse outcomes in HCM patients compared to non-severe obstruction (50.0% vs. 31.6%; HR 1.87, P=0.009).

synapsesocial.com/papers/69d896566c1944d70ce07b06 https://doi.org/10.1093/ehjqcco/qcag056

Topics

Hypertrophic cardiomyopathy

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Severe LVOT obstruction in HCM: effects on exercise capacity and outcomes from cardiopulmonary exercise testing combined with stress echocardiography

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Topics

Severe LVOT obstruction in HCM: effects on exercise capacity and outcomes from cardiopulmonary exercise testing combined with stress echocardiography

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Topics

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