ArticleESC heart failure2026
Long-term prognostic value of cardiopulmonary exercise testing in patients with hypertrophic cardiomyopathy.
Article in ESC heart failure, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionHypertrophic cardiomyopathy (HCM) is a heterogeneous myocardial disorder characterized by left ventricular 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.
methodsWe longitudinally studied 154 HCM patients (age 43 ± 16 years; 27% female), who underwent symptom-limited CPET. At baseline, 98 patients were in New York Heart Association (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.
resultsOver 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 [hazard ratio (HR) 4.16, 95% confidence interval (CI) 1.89-9.14; P < .001], and NYHA Class >I (HR 2.27, 95% CI 1.06-4.89; P = .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 = .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 = .006), with risk divergence evident after nearly 15 years of follow-up. The result was also confirmed in the competing risk analysis.
conclusionIn 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.
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