Evidence map›Paper›PMID 41954058›Full record

ArticleJournal of the American Heart Association2026

RoMa: A Cardiopulmonary Exercise Testing Based Risk Tool in Hypertrophic Cardiomyopathy.

Robin Willixhofer, Massimo Mapelli, Nikita Baracchini, Nicola Campana, Teresa Maria Capovilla, Alessandro Nava, Elisabetta Salvioni, Carlo Vignati, Filippo Maria Rubbo, Damiano Magrì and 15 more

Abstract readMulticenter Study
In one paragraph

Article in Journal of the American Heart Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. RoMa Classification: When the Parts Do Not Equal the Sum.Journal of the American Heart Association · 2026
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

25 authors.

Robin WillixhoferCentro Cardiologico Monzino, IRCCS Milan Italy.ORCID 0000-0003-3405-5715
Massimo MapelliCentro Cardiologico Monzino, IRCCS Milan Italy.ORCID 0000-0001-9985-7407
Nikita BaracchiniCardiovascular Department Center for Diagnosis and Treatment of Cardiomyopathies Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste Trieste Italy.ORCID 0000-0003-1408-8544
Nicola CampanaCentro Cardiologico Monzino, IRCCS Milan Italy.
Teresa Maria CapovillaCardiovascular Department Center for Diagnosis and Treatment of Cardiomyopathies Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste Trieste Italy.ORCID 0000-0002-9153-4686
Alessandro NavaAzienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste Trieste Italy.
Elisabetta SalvioniCentro Cardiologico Monzino, IRCCS Milan Italy.
Carlo VignatiCentro Cardiologico Monzino, IRCCS Milan Italy.ORCID 0000-0002-8235-9353
Filippo Maria RubboCentro Cardiologico Monzino, IRCCS Milan Italy.ORCID 0009-0006-7940-9811
Damiano MagrìDepartment of Clinical and Molecular Medicine Azienda Ospedaliera Sant'Andrea, 'Sapienza' Università degli Studi di Roma Rome Italy.
Emiliano FioriDepartment of Clinical and Molecular Medicine Azienda Ospedaliera Sant'Andrea, 'Sapienza' Università degli Studi di Roma Rome Italy.ORCID 0000-0001-8749-8558
Beatrice PezzutoCentro Cardiologico Monzino, IRCCS Milan Italy.
Irene MattavelliCentro Cardiologico Monzino, IRCCS Milan Italy.ORCID 0000-0002-7781-1691
Anna ApostoloCentro Cardiologico Monzino, IRCCS Milan Italy.
Pietro PalermoCentro Cardiologico Monzino, IRCCS Milan Italy.ORCID 0000-0003-1621-7944
Jeness CampodonicoCentro Cardiologico Monzino, IRCCS Milan Italy.ORCID 0000-0003-2276-9630
Mauro ContiniCentro Cardiologico Monzino, IRCCS Milan Italy.ORCID 0000-0003-4727-9339
Simona CostantinoCentro Cardiologico Monzino, IRCCS Milan Italy.
Cosimo CarriereCardiovascular Department Center for Diagnosis and Treatment of Cardiomyopathies Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste Trieste Italy.ORCID 0000-0003-4188-1919
Irena TavčarCardiovascular Department Center for Diagnosis and Treatment of Cardiomyopathies Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste Trieste Italy.ORCID 0009-0002-5659-9449
Maddalena RossiCardiovascular Department Center for Diagnosis and Treatment of Cardiomyopathies Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste Trieste Italy.ORCID 0000-0003-2052-4066
Christian Cadeddu DessalviDepartment of Medical Sciences and Public Health University of Cagliari Cagliari Italy.
Marco MerloCardiovascular Department Center for Diagnosis and Treatment of Cardiomyopathies Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste Trieste Italy.ORCID 0000-0002-1022-3131
Gianfranco SinagraCardiovascular Department Center for Diagnosis and Treatment of Cardiomyopathies Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste Trieste Italy.ORCID 0000-0003-2700-8478
Piergiuseppe AgostoniCentro Cardiologico Monzino, IRCCS Milan Italy.ORCID 0000-0002-8345-6382

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe RoMa classification, based on peak heart rate and oxygen pulse derived from cardiopulmonary exercise testing, was recently proposed to stratify patients with hypertrophic cardiomyopathy by physiological reserve during exercise. We aimed to externally validate RoMa in an independent multicenter cohort with hypertrophic cardiomyopathy and assess its association with long-term clinical outcomes.

methodsIn this retrospective multicenter cohort study patients with hypertrophic cardiomyopathy, undergoing cardiopulmonary exercise testing, were consecutively enrolled. Patients were enrolled regardless of left ventricular outflow tract obstruction and were naïve to disease-specific therapy (eg, mavacamten). Patients were categorized into RoMa I to IV based on percentage of predicted heart rate and oxygen pulse. The primary end point was a composite of all-cause and cardiovascular death, sudden cardiac death, or aborted sudden cardiac death, heart failure-related hospitalization, stroke, systemic embolism, surgical myectomy, and heart transplantation.

resultsThe study included 292 patients (age 51 [36-63] years, 70% male sex, 30% with obstructive left ventricular outflow tract). Functional capacity declined hierarchically across RoMa groups (peak oxygen uptake 29.2 to 17.9 mL/kg/min;

conclusionsThe RoMa classification independently predicts long-term, clinically relevant outcomes in hypertrophic cardiomyopathy regardless of left ventricular outflow tract obstruction and may provide a novel approach to risk stratification.

Indexed as

Cardiomyopathy, HypertrophicExercise TestExercise ToleranceHeart RateAdultDeath, Sudden, CardiacFemaleHumansMaleMiddle AgedOxygen ConsumptionPredictive Value of TestsPrognosisRetrospective StudiesRisk AssessmentRisk Factorscardiopulmonary exercise testingheart ratehypertrophic cardiomyopathyprognosisstroke volume

Identifiers

PMID41954058
PMCPMC13279055

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.