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Risk stratification in cardiomyopathy

Gianfranco Sinagra1, Cosimo Carriere1, Francesco Clemenza2

  • 1Cardiothoracovascular Department of Trieste, University of Trieste, Italy.

European Journal of Preventive Cardiology
|November 26, 2020
PubMed

Insights

Cardiopulmonary exercise testing (CPET) offers crucial prognostic insights for cardiomyopathies, aiding risk stratification beyond traditional heart failure metrics. Integrating CPET data into scores like the Metabolism Exercise Cardiac Kidney Index enhances patient management and outcomes.

Area of Science:

  • Cardiology
  • Exercise Physiology
  • Clinical Risk Stratification

Background:

  • Accurate prognostic stratification is vital for managing cardiomyopathies, primarily focusing on arrhythmic events and heart failure.
  • Traditional risk assessment often overlooks valuable data obtainable through cardiopulmonary exercise testing (CPET).
  • Existing risk scores may not fully capture the prognostic nuances of various cardiomyopathies.

Purpose of the Study:

  • To evaluate the role of cardiopulmonary exercise testing (CPET) in improving prognostic stratification for patients with cardiomyopathies.
  • To explore specific CPET parameters and their correlation with prognosis across different cardiomyopathy types.
  • To advocate for the routine integration of CPET into advanced heart failure center evaluations for comprehensive risk assessment.

Main Methods:

  • Analysis of cardiopulmonary exercise testing (CPET) data, including peak oxygen consumption, ventilation/carbon dioxide production slope, and chronotropic competence.
  • Integration of CPET-derived variables into established risk stratification scores, such as the Metabolism Exercise Cardiac Kidney Index.
  • Review of existing literature on CPET findings in hypertrophic, dilated, arrhythmogenic, and restrictive cardiomyopathies.

Main Results:

  • In hypertrophic cardiomyopathy, reduced peak oxygen consumption, increased ventilation/carbon dioxide production slope, and chronotropic incompetence are linked to poorer prognosis.
  • In dilated cardiomyopathy, the percentage of peak oxygen consumption and the ventilation/carbon dioxide production slope are associated with increased cardiovascular risk.
  • Limited data exist for arrhythmogenic and restrictive cardiomyopathies, highlighting a need for further research.

Conclusions:

  • Cardiopulmonary exercise testing (CPET) provides significant prognostic information for cardiomyopathies, complementing traditional assessments.
  • Specific CPET variables demonstrate utility in risk stratifying patients with hypertrophic and dilated cardiomyopathies.
  • Early and routine referral to specialized centers for comprehensive risk stratification including CPET is recommended for all cardiomyopathy patients.

Keywords:
CPETCardiomyopathyMECKY scoreexerciseprognosisrisk stratification

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