Cardiopulmonary Exercise Testing in Athletes With Hypertrophic Cardiomyopathy

Newman, Darrell B.; Garmany, Ramin; Contreras, Alejandra Meza; Bos, J. Martijn; Johnson, Jonathan N.; Allison, Thomas G.; Ommen, Steve R.; Ackerman, Michael J.

doi:10.1016/j.amjcard.2022.11.008

Cited by 4 publications

(3 citation statements)

References 19 publications

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“…CPET provides a detailed and comprehensive way to approach the complex pathophysiology of HCM and can be a useful tool in assessing prognosis and treatment, especially in recognizing patients with a higher risk for sudden cardiac death and HF development [ 7 , 16 ]. CPET is also a useful tool in differentiating HCM from other forms of LV hypertrophy, such as athletes’ heart, as well as in the evaluation of athletes with a confirmed diagnosis of HCM [ 17 ]. Moreover, CPET is used to monitor therapeutic efficacy in this patient population [ 18 ].…”

Section: Exercise Testing To Assess Hcmmentioning

confidence: 99%

“…The fact that, in the earlier mentioned study by Masri et al, only 8% of patients with HCM achieved >100% age-gender predicted peak VO 2 [ 22 ] can be a valuable clinical measure in the differentiation between physiologic LV hypertrophy in athletes and HCM, especially in the so called “gray zone” [ 25 ]. Recently, 58 athletes with HCM evaluated at the Mayo Clinic were found to have a mildly reduced exercise capacity (83% of predicted); however, a reduced peak VO 2 did not correlate with symptom status or clinical outcomes [ 17 ]. The fact that two recent clinical trials that evaluated the usage of the new therapeutic drug mavacamten in the treatment of obstructive HCM, EXPLORER, and PIONEER HCM used the change in peak VO 2 as both primary and secondary endpoints, or only the secondary endpoint, indicates the importance of functional testing in the management of HCM [ 26 , 27 ].…”

Section: Aerobic Capacity—peak Vomentioning

confidence: 99%

“…However, there are some new perspectives that are suggesting that, in some cases, participation in competitive sports can be safely managed. More data is needed to provide objective safety evaluations and decision making, for example, after septal reduction procedures or ICD implantation have been performed [ 17 ]. The ESC Preventive Cardiology guidelines suggest individual decision making and recommend (Class IIc) exercise testing to assess for the appearance of exercise-induced ventricular tachycardia, a significant increase in the LV outflow gradient (>50 mmHg), or ABPRE.…”

Section: Recommendations For Exercise Prescription In Hypertrophic Ca...mentioning

confidence: 99%

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The Role of Cardiopulmonary Exercise Testing in Hypertrophic Cardiomyopathy

Mikic,

Ristic,

Markovic Nikolic

et al. 2023

Medicina

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This review emphasizes the importance of cardiopulmonary exercise testing (CPET) in patients diagnosed with hypertrophic cardiomyopathy (HCM). In contrast to standard exercise testing and stress echoes, which are limited due to the ECG changes and wall motion abnormalities that characterize this condition, CPET allows for the assessment of the complex pathophysiology and severity of the disease, its mechanisms of functional limitation, and its risk stratification. It is useful tool to evaluate the risk for sudden cardiac death and select patients for cardiac resynchronization therapy (CRT), cardiac transplantation, or mechanical circulatory support, especially when symptomatology and functional status are uncertain. It may help in differentiating HCM from other forms of cardiac hypertrophy, such as athletes’ heart. Finally, it is used to guide and monitor therapy as well as for exercise prescription. It may be considered every 2 years in clinically stable patients or every year in patients with worsening symptoms. Although performed only in specialized centers, CPET combined with echocardiography (i.e., CPET imaging) and invasive CPET are more informative and provide a better assessment of cardiac functional status, left ventricular outflow tract obstruction, and diastolic dysfunction during exercise in patients with HCM.

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