Cardiopulmonary Exercise Test in Patients with Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis

Area of Science:

• Cardiology
• Exercise Physiology
• Clinical Assessment

Background:

• Chronic disease management often involves lifestyle adaptations based on functional limitations.
• Functional capacity in Hypertrophic Cardiomyopathy (HCM) is crucial and can be assessed using stress testing.
• Cardiopulmonary Exercise Test (CPET) provides objective measurements for evaluating patient responses to therapies in HCM.

Purpose of the Study:

• To systematically review and analyze existing literature on the utility of CPET in patients with HCM.
• To evaluate the role of objective CPET measurements in assessing patient response to traditional and novel therapeutic interventions for HCM.

Main Methods:

• A systematic literature review was conducted across PubMed, Web of Science, and Cochrane databases.
• Included 69 full-text articles from an initial search of 2628 results, focusing on 17 selected variables.
• Data synthesis included comorbidities, BMI, symptoms, echocardiographic data, medications, and outcomes.

Main Results:

• The review analyzed data from 11,672 HCM patients across 69 studies, with treadmill and cycle-ergometers being common testing modalities.
• Mean maximal oxygen consumption (VO2max) was 22.3 mL·kg⁻¹·min⁻¹, with higher values observed on cycle-ergometers.
• Lower VO2max was significantly associated with adverse cardiovascular outcomes, including death, while exercise intolerance was linked to age, medication, and comorbidities rather than HCM phenotype.

Conclusions:

• CPET is a safe and valuable tool for assessing functional capacity in HCM patients.
• VO2max is a key performance metric, with cycle-ergometer tests yielding higher values than treadmill tests.
• Exercise intolerance in HCM is more influenced by age, medication, and comorbidities than the specific HCM phenotype.