Key result
RoMa classification stratifies ATTR-CM functional capacity, showing a ~107-meter drop in 6MWD across stages.
Why the study?
To evaluate the applicability of the RoMa classification in patients with transthyretin cardiac amyloidosis and assess its association with functional capacity and key CPET parameters.
Does the RoMa classification identify distinct exercise-response profiles associated with functional impairment in patients with ATTR-CM?
Observational (n=165)
Yes
Does the RoMa classification identify distinct exercise-response profiles associated with functional impairment in patients with ATTR-CM?
The RoMa classification provides a feasible, CPET-based framework for functional phenotyping in ATTR-CM that correlates with exercise capacity and ventilatory efficiency.
AIMS: To evaluate the applicability of the RoMa classification in patients with transthyretin cardiac amyloidosis (ATTR-CM) and to assess its association with functional capacity and key cardiopulmonary exercise testing (CPET) parameters. METHODS: Consecutive adults (≥18 years) with confirmed ATTR-CM from two tertiary centres who completed symptom-limited maximal CPET were included. RoMa classes were defined using predefined cutoffs for percent-predicted peak heart rate (HRpp ≥80%) and percent-predicted peak O2-pulse (O2pp ≥100%): RoMa I (high HRpp/high O2pp), RoMa II (high HRpp/low O2pp), RoMa III (low HRpp/high O2pp), and RoMa IV (low HRpp/low O2pp). RESULTS: We evaluated 165 patients (90% male; 77% wild-type ATTR, 20% variant ATTR). RoMa distribution was: RoMa I, n=33; RoMa II, n=73; RoMa III, n=30; and RoMa IV, n=29. Age did not differ across classes (p=0.36). Functional capacity declined across the RoMa strata: median 6MWD decreased from 420 m (RoMa I) to 313 m (RoMa IV) (overall p=0.009; p-trend=0.005), and NYHA class worsened (overall p=0.003; p-trend=0.005). Peak VO2 (% predicted) differed between groups (RoMa I: 93.0; II: 70.8; III: 75.2; IV: 51.9; overall p<0.001; p-trend<0.001), and ventilatory inefficiency increased (VE/VCO2 slope: 34; 39; 37; 47, respectively; overall p<0.001; p-trend<0.001; peak PetCO2: 30; 27; 29; 25, respectively; overall p<0.001; p-trend=0.003). 6MWD correlated with peak VO2 (r=0.626; p<0.001; n=131) and inversely with VE/VCO2 slope (ρ=-0.484; p<0.001; n=130). CONCLUSION: In ATTR-CM, application of the RoMa classification was feasible and identified distinct CPET-derived exercise-response profiles associated with functional impairment. These findings support RoMa as a promising exploratory framework for functional phenotyping in ATTR-CM.
No takes yet. Share an insight, caveat, or question.
Kösters et al. (2026) conducted an observational in Transthyretin cardiac amyloidosis (ATTR-CM) (n=165). RoMa classification (HRpp ≥80% and O2pp ≥100%) vs. Across RoMa classes I to IV was evaluated on 6-minute walk distance (6MWD) (p=0.009). The RoMa classification identified distinct exercise-response profiles in ATTR-CM, with median 6-minute walk distance declining from 420 m in RoMa I to 313 m in RoMa IV (p=0.009).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: