What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertrophic cardiomyopathy (n=388). Intervention: Severe dynamic LVOT obstruction (peak gradient ≥80 mmHg) vs. Non-severe LVOT obstruction (<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 does this research mean for the field?

In hypertrophic cardiomyopathy, severe dynamic left ventricular outflow tract obstruction (≥80 mmHg) independently predicts impaired exercise capacity and adverse clinical outcomes, whereas intermediate gradients are associated with generally preserved outcomes. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the relationship between the severity of left ventricular outflow tract (LVOT) gradient and both functional exercise performance and long-term clinical prognosis in hypertrophic cardiomyopathy.

September 15, 2026European Heart Journal Supplements

Unmasking the Impact of Severe Lvot Obstruction in Hypertrophic Cardiomyopathy by Combined Stress Echocardiography and Cardiopulmonary Exercise Testing

Q: What are the key findings of this study?

Severe dynamic LVOT obstruction (≥80 mmHg) independently predicted a higher risk of adverse clinical outcomes in patients with hypertrophic cardiomyopathy (50.0% vs 31.6%; HR 1.87, p=0.009).

Q: What does this research mean for the field?

In hypertrophic cardiomyopathy, severe dynamic left ventricular outflow tract obstruction (≥80 mmHg) independently predicts impaired exercise capacity and adverse clinical outcomes, whereas intermediate gradients are associated with generally preserved outcomes. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

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Key result

Severe dynamic LVOT obstruction predicts ~87% higher risk of adverse clinical outcomes in HCM.

HR 1.87
P=0.009
n=388

Why the study?

Although LVOT obstruction influences functional capacity and clinical outcomes in HCM, the clinical relevance of varying obstruction severity remains debated.

Does severe LVOT obstruction (≥80 mmHg) predict worse exercise performance and long-term prognosis in patients with hypertrophic cardiomyopathy?

Population

388 HCM patients undergoing TTE-CPET

Comparison

Peak LVOT gradient <30 mmHg vs 30-49 mmHg vs 50-79 mmHg vs >=80 mmHg

Design

Retrospective cohort study

Follow-up

Median follow-up of 7.4 years

Authors

RMR MistrulliAzienda Ospedaliera Sant'Andrea FRF ReAzienda Ospedaliera Sant'Andrea GGG GiacaloneAzienda Ospedaliera Sant'Andrea

Discussion

Member takes

Implication

May identify high-risk HCM patients for closer monitoring; leaves open whether gradient-targeted intervention improves outcomes.

Key Points

To evaluate the relationship between the severity of left ventricular outflow tract (LVOT) gradient and both functional exercise performance and long-term clinical prognosis in hypertrophic cardiomyopathy.
Retrospectively analyzed 388 patients with hypertrophic cardiomyopathy evaluated by combined stress echocardiography and cardiopulmonary exercise testing (TTE-CPET).
Stratified patients into four categories based on peak LVOT gradient: <30 mmHg, 30–49 mmHg, 50–79 mmHg, and ≥80 mmHg.
Tracked a composite primary outcome of NYHA functional class worsening, heart failure hospitalization, new-onset atrial fibrillation, or progression to end-stage disease over a median follow-up of 7.4 years.
Patients with severe dynamic obstruction (peak gradient ≥80 mmHg, n=82) demonstrated significantly lower peak VO₂ compared to those with gradients <80 mmHg (15.9 vs. 19.7 ml/kg/min, p=0.003).
The severe obstruction cohort exhibited a significantly higher rate of adverse events (50.0% vs. 31.6%, p=0.011) and worse overall event-free survival (log-rank p=0.011).
A peak LVOT gradient of ≥80 mmHg independently predicted adverse outcomes on multivariable analysis (HR: 1.87, p=0.009), whereas intermediate gradients (30–79 mmHg) showed largely preserved outcomes.

Study Design

Type

Cohort (n=388)

Structured PICO

Does severe LVOT obstruction (≥80 mmHg) predict worse exercise performance and long-term prognosis in patients with hypertrophic cardiomyopathy?

Population

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

Exposure

Severe dynamic LVOT obstruction (peak LVOT gradient ≥80 mmHg)

Comparator

Lower peak LVOT gradients (<30 mmHg, 30-49 mmHg, 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) identifies a high-risk subgroup of HCM patients with impaired exercise capacity and worse long-term prognosis, highlighting the value of TTE-CPET for risk stratification.

Cite This Study

Mistrulli et al. (2026) conducted a cohort in Hypertrophic cardiomyopathy (n=388). Severe dynamic LVOT obstruction (peak gradient ≥80 mmHg) vs. Non-severe LVOT obstruction (<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 a higher risk of adverse clinical outcomes in patients with hypertrophic cardiomyopathy (50.0% vs 31.6%; HR 1.87, p=0.009).

synapsesocial.com/papers/6aa90187eed42882c1fc1a11 https://doi.org/10.1093/eurheartjsupp/suag058.048

Topics

Heart failure HFrEF treatment HFpEF management

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Unmasking the Impact of Severe Lvot Obstruction in Hypertrophic Cardiomyopathy by Combined Stress Echocardiography and Cardiopulmonary Exercise Testing

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Topics

Unmasking the Impact of Severe Lvot Obstruction in Hypertrophic Cardiomyopathy by Combined Stress Echocardiography and Cardiopulmonary Exercise Testing

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Topics

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