Publication:
Cardiopulmonary Exercise test in patients with hypertrophic cardiomyopathy: a systematic review and meta-analysis

Simple item page
dc.contributor.authorBayonas Ruiz, Adrián
dc.contributor.authorMuñoz Franco, Francisca M.
dc.contributor.authorFerrer Pérez, Vicente
dc.contributor.authorPérez Caballero, Carlos
dc.contributor.authorSabater Molina, María
dc.contributor.authorTomé Esteban, María Teresa
dc.contributor.authorBonacasa Fernández, Bárbara
dc.contributor.departmentFisiología
dc.date.accessioned2026-02-06T12:22:34Z
dc.date.available2026-02-06T12:22:34Z
dc.date.copyright© 2021 by the authors
dc.date.issued2021-05-25
dc.description.abstractBackground: Patients with chronic diseases frequently adapt their lifestyles to their functional limitations. Functional capacity in Hypertrophic Cardiomyopathy (HCM) can be assessed by stress testing. We aim to review and analyze the available data from the literature on the value of Cardiopulmonary Exercise Test (CPET) in HCM. Objective measurements from CPET are used for evaluation of patient response to traditional and new developing therapeutic measurements. Methods: A systematic review of the literature was conducted in PubMed, Web of Science and Cochrane in Mar-20. The original search yielded 2628 results. One hundred and two full texts were read after the first screening, of which, 69 were included for qualitative synthesis. Relevant variables to be included in the review were set and 17 were selected, including comorbidities, body mass index (BMI), cardiac-related symptoms, echocardiographic variables, medications and outcomes. Results: Study sample consisted of 69 research articles, including 11,672 patients (48 ± 14 years old, 65.9%/34.1% men/women). Treadmill was the most common instrument employed (n = 37 studies), followed by upright cycle-ergometer (n = 16 studies). Mean maximal oxygen consumption (VO2max) was 22.3 ± 3.8 mL·kg−1·min−1. The highest average values were observed in supine and upright cycle-ergometer (25.3 ± 6.5 and 24.8 ± 9.1 mL·kg−1·min−1; respectively). Oxygen consumption in the anaerobic threshold (ATVO2) was reported in 18 publications. Left ventricular outflow tract gradient (LVOT) > 30 mmHg was present at baseline in 31.4% of cases. It increased to 49% during exercise. Proportion of abnormal blood pressure response (ABPRE) was higher in severe (>20 mm) vs. mild hypertrophy groups (17.9% vs. 13.6%, p < 0.001). Mean VO2max was not significantly different between severe vs. milder hypertrophy, or for obstructive vs. non-obstructive groups. Occurrence of arrhythmias during functional assessment was higher among younger adults (5.42% vs. 1.69% in older adults, p < 0.001). Twenty-three publications (9145 patients) evaluated the prognostic value of exercise capacity. There were 8.5% total deaths, 6.7% cardiovascular deaths, 3.0% sudden cardiac deaths (SCD), 1.2% heart failure death, 0.6% resuscitated cardiac arrests, 1.1% transplants, 2.6% implantable cardioverter defibrillator (ICD) therapies and 1.2 strokes (mean follow-up: 3.81 ± 2.77 years). VO2max, ATVO2, METs, % of age-gender predicted VO2max, % of age-gender predicted METs, ABPRE and ventricular arrhythmias were significantly associated with major outcomes individually. Mean VO2max was reduced in patients who reached the combined cardiovascular death outcome compared to those who survived (−6.20 mL·kg−1·min−1; CI 95%: −7.95, −4.46; p < 0.01). Conclusions: CPET is a valuable tool and can safely perform for assessment of physical functional capacity in patients with HCM. VO2max is the most common performance measurement evaluated in functional studies, showing higher values in those based on cycle-ergometer compared to treadmill. Subgroup analysis shows that exercise intolerance seems to be more related to age, medication and comorbidities than HCM phenotype itself. Lower VO2max is consistently seen in HCM patients at major cardiovascular risk.
dc.formatapplication/pdf
dc.format.extent24
dc.identifier.citationJ. Clin. Med. 2021, 10(11), 2312
dc.identifier.doihttps://doi.org/10.3390/jcm10112312
dc.identifier.eissn2077-0383
dc.identifier.urihttp://hdl.handle.net/10201/200929
dc.languageeng
dc.publisherMDPI
dc.relationSin financiación externa a la Universidad
dc.relation.publisherversionhttps://www.mdpi.com/2077-0383/10/11/2312
dc.rightsAttribution 4.0 International*
dc.rights.accessRightsinfo:eu-repo/semantics/openAccess
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/*
dc.subjectHypertrophic cardiomyopathy
dc.subjectPhysical activity
dc.subjectExercise test
dc.subjectPathophysiology
dc.subjectPrognosis
dc.subject.odsObjetivo 3: Salud
dc.titleCardiopulmonary Exercise test in patients with hypertrophic cardiomyopathy: a systematic review and meta-analysis
dc.typeinfo:eu-repo/semantics/article
dc.type.versioninfo:eu-repo/semantics/publishedVersion
dspace.entity.typePublicationes
relation.isAuthorOfPublicationd6a92b0d-7c47-45dd-9945-564ff6e6cc3e
relation.isAuthorOfPublicationf4a8b11b-9980-45e4-9d87-c430bde8beb2
relation.isAuthorOfPublication6a642dfb-d0e6-4dcf-ae7e-c19949e99a85
relation.isAuthorOfPublication.latestForDiscoveryd6a92b0d-7c47-45dd-9945-564ff6e6cc3e
Files
Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
2021 - The Journal of Clinical Medicine - Cardiopulmonary Exercise Test in Patients with Hypertrophic.pdf
Size:
3.2 MB
Format:
Adobe Portable Document Format
Description:
Download
License bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
license.txt
Size:
1.37 KB
Format:
Item-specific license agreed upon to submission
Description:
Download
Collections
Artículos