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Long-term prognostic value of cardiopulmonary exercise testing in patients with hypertrophic cardiomyopathy

Leopoldo Ordine1, Grazia Canciello1, Salvatore Di Napoli1

  • 1Department of Advanced Biomedical Sciences, University of Naples 'Federico II', School of Medicine, Via S Pansini, 5, Naples I-80131, Italy.

ESC Heart Failure
|February 19, 2026
PubMed

Insights

Cardiopulmonary exercise testing (CPET) is a powerful prognostic tool for hypertrophic cardiomyopathy (HCM). A reduced peak oxygen uptake (VO2) predicts major adverse cardiac events (MACE), even in asymptomatic patients.

Area of Science:

  • Cardiology
  • Exercise Physiology

Background:

  • Hypertrophic cardiomyopathy (HCM) is a complex myocardial disease.
  • The prognostic value of cardiopulmonary exercise testing (CPET) in predicting major adverse cardiac events (MACE) in HCM requires further clarification, especially in long-term outcomes and independent of initial symptoms.

Purpose of the Study:

  • To evaluate the long-term predictive capability of CPET for MACE in patients with HCM.
  • To determine if CPET findings can stratify risk independently of baseline symptoms.

Main Methods:

  • A longitudinal study of 154 HCM patients who underwent symptom-limited CPET.
  • MACE included septal reduction therapies, end-stage HCM, sudden cardiac death, and heart failure-related death or transplantation.
  • Multivariable and competing risk analyses were performed over a mean follow-up of 12 years.

Main Results:

  • Reduced percentage predicted peak VO2 (PVO2%) < 60% was an independent predictor of MACE (HR 4.16).
  • NYHA Class >I also predicted MACE (HR 2.27).
  • In asymptomatic (NYHA Class I) patients, PVO2% < 60% remained a significant predictor of MACE (HR 5.611), with risk divergence after 15 years.

Conclusions:

  • CPET is a potent prognostic tool for risk stratification in HCM patients.
  • A reduced peak VO2 is a key indicator of increased risk for MACE.
  • CPET can enhance risk assessment, including for asymptomatic individuals.
Abstract

Keywords:
Cardiopulmonary exercise testingExercise capacityHeart failureHypertrophic cardiomyopathyPreventive cardiologyPrognosis

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