Key result
Asymptomatic cardiomyopathy patients develop new cardiovascular risk factors at a ~12% rate, driven by hypertension.
Why the study?
Cardiovascular disease risk factors increase morbidity in cardiomyopathies, but whether new-onset risk factors or acute exercise responses during CPET differ among cardiomyopathy types is unknown.
Do new-onset cardiovascular disease risk factors and acute exercise responses during CPET differ among patients with different types of cardiomyopathies?
Cohort (n=104)
No
Do new-onset cardiovascular disease risk factors and acute exercise responses during CPET differ among patients with different types of cardiomyopathies?
Exercise limitations and cardiopulmonary exercise testing parameters differ significantly among cardiomyopathy phenotypes and by sex, highlighting the need for individualized assessment.
Low new-onset CV risk factor incidence may not warrant aggressive monitoring in asymptomatic cardiomyopathies; leaves open CPET phenotype differences.
Phenotype determines function. Resting echocardiography and cardiopulmonary exercise testing reveal reduced systolic and diastolic function, exercise capacity (peak oxygen consumption, VO 2 peak), oxygen pulse (O 2 pulse), circulatory (CP) and ventilatory (VP) power as well as lower peak systolic blood pressure (SBP peak ) in patients with dilated (DCM) compared to arrhythmogenic (ACM) and hypertrophic (HCM) cardiomyopathy. Thus, exercise testing and cardiomyopathy should be used to analyze circulatory limitations in patients with cardiomyopathies. Images created with smart.servier.com and biorender.com. Cardiovascular disease risk factors (CVDRF) are linked to increased morbidity in cardiomyopathies (CMP), but whether new onset CVDRF differ among CMPs is unknown. In addition, whether the acute exercise response during cardiopulmonary exercise testing (CPET) differs among CMPs remains unclear. This single-center, retrospective study analyzed patients with arrhythmogenic, hypertrophic, and dilated (DCM) cardiomyopathy without CVDRF at baseline. Resting echocardiography and CPET were performed, and exercise response was assessed depending on sex and CMP. After a median follow-up of 19.5 months, CPET and echocardiography were analyzed in relation to the development of new CVDRF. A total of 104 CMPs were included (median age 53.0 years). New-onset CVDRF was rare (11.5 %) and driven by arterial hypertension (8.7 %) but did not differ among CMPs. DCM displayed significantly lower resting left ventricular ejection fraction (40.5 %, interquartile range, IQR, 11.5 %, p < 0.001), diastolic function (E/e‘ 9.3, IQR 5.5, p < 0.001), and had the lowest peak systolic blood pressure (170.0 mmHg, IQR 52.5 mmHg, p = 0.011), predicted peak oxygen consumption (82.0 %, IQR 39.8 %, p = 0.003), oxygen pulse (101.0 %, IQR 28.8 %, p = 0.030) as well as lower ventilatory (VP, 5.5 mmHg, IQR 1.4 mmHg, p = 0.033) and circulatory (CP, 4096.0 mL/kg/min x mmHg, IQR 2299.3 mL/kg/min x mmHg, p = 0.015) power compared to the other groups. Lower VP (5.0 mmHg, IQR 1.3 mmHg, p = 0.003) and CP (3660.0 mL/kg/min x mmHg, IQR 3298.0 mL/kg/min x mmHg, p = 0.004) were observed for females. Arterial hypertension was the most common CVDRF among CMPs, underscoring the importance of monitoring this outcome. Exercise limitations differ between CMPs and should be interpreted depending on sex.
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Wernhart et al. (2025) conducted a cohort in Cardiomyopathy (arrhythmogenic, hypertrophic, and dilated) (n=104). In asymptomatic patients with cardiomyopathies, the incidence of new-onset cardiovascular risk factors was low at 11.5% over a median 19.5 months and was primarily driven by arterial hypertension.
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