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Heart Failure Progression in Hypertrophic Cardiomyopathy - Possible Insights From Cardiopulmonary Exercise Testing
Damiano Magrì1, Federica Re, Giuseppe Limongelli
1Department of Clinical and Molecular Medicine, University of Rome "La Sapienza"
Insights
Cardiopulmonary exercise testing (CPET) aids in predicting heart failure (HF) events in hypertrophic cardiomyopathy (HCM). The new HYPERHF score, using CPET data, helps identify high-risk HCM patients needing closer monitoring for HF progression.
Area of Science:
- Cardiology
- Exercise Physiology
Background:
- Heart failure (HF) progression is a significant concern in hypertrophic cardiomyopathy (HCM).
- Predicting HF-related events in HCM patients is crucial for timely intervention.
Purpose of the Study:
- To investigate the role of cardiopulmonary exercise testing (CPET) in predicting HF-related events in HCM.
- To develop and validate an exercise-derived risk model, the HYPERHF score.
Main Methods:
- A multicenter cohort of 620 HCM outpatients was followed from 2007 to 2015.
- The study endpoint included death from HF, cardiac transplantation, and HF worsening hospitalizations.
- Key parameters like peak circulatory power, ventilatory efficiency, and left atrial diameter were analyzed.
Main Results:
- 84 patients reached the endpoint during a median follow-up of 3.8 years.
- Peak circulatory power, ventilatory efficiency, and left atrial diameter were independently associated with adverse outcomes.
- The HYPERHF model demonstrated strong predictive accuracy (C-index: 0.849).
Conclusions:
- Cardiopulmonary exercise testing (CPET) is a valuable tool for evaluating HCM patients.
- The HYPERHF score can facilitate early identification of HCM patients at high risk for HF progression.
- This risk stratification may guide clinical management and improve patient outcomes.
Background:
Heart failure (HF) progression and its complications represent major emergent concerns in hypertrophic cardiomyopathy (HCM). We investigated the possible adjunctive role of cardiopulmonary exercise testing (CPET) in predicting HF-related events. An exercise-derived risk model, theHYPertrophicExercise-derivedRiskHF(HYPERHF), has been developed.
Methods And Results:
A multicenter cohort of 620 consecutive HCM outpatients was recruited and followed (2007 to 2015). The endpoint was death from HF, cardiac transplantation, NYHA III-IV class progression, severe functional deterioration leading to hospitalization for septal reduction, and hospitalization for HF worsening. During a median follow-up of 3.8 years (25-75th centile: 2.3-5.3 years), 84 patients reached the endpoint. Peak circulatory power (peak oxygen consumption * peak systolic blood pressure), ventilatory efficiency and left atrial diameter were independently associated with the endpoint and, accordingly, integrated into the HYPERHFmodel (C index: 0.849; best cutoff value equal to 15%).
Conclusions:
CPET is useful in the evaluation of HCM patients. In this context, the HYPERHFscore might allow early identification of those patients at high risk of HF progression and its complications. (Circ J 2016; 80: 2204-2211).
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