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

Area of Science:

• Cardiology
• Exercise Physiology
• Genetics

Background:

• The RoMa classification, using peak heart rate and oxygen pulse from cardiopulmonary exercise testing (CPET), was proposed to stratify hypertrophic cardiomyopathy (HCM) patients by exercise physiological reserve.
• External validation of the RoMa classification in an independent multicenter HCM cohort was needed to assess its association with long-term clinical outcomes.

Purpose of the Study:

• To externally validate the RoMa classification in a multicenter cohort of patients with hypertrophic cardiomyopathy.
• To assess the association of the RoMa classification with long-term clinical outcomes in HCM patients.

Main Methods:

• Retrospective multicenter cohort study of 292 HCM patients undergoing CPET, naive to disease-specific therapy.
• Patients were categorized into RoMa I-IV based on predicted heart rate and oxygen pulse.
• Primary endpoint was a composite of major adverse cardiovascular events, including death, hospitalization, stroke, and interventions.

Main Results:

• Functional capacity declined hierarchically across RoMa groups (peak oxygen uptake 29.2 to 17.9 mL/kg/min; P-trend <0.001).
• During ~6 years follow-up, RoMa II-IV independently predicted higher risk for the composite outcome compared to RoMa I (HRs, 3.89-5.37; P<0.05).
• Genotype, LVEF <50%, male sex, and LVOTO obstruction were not predictive.

Conclusions:

• The RoMa classification independently predicts long-term, clinically relevant outcomes in hypertrophic cardiomyopathy.
• This classification may offer a novel approach to risk stratification in HCM, irrespective of left ventricular outflow tract obstruction.