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<p>In hypertrophic cardiomyopathy (HCM), cardiopulmonary exercise testing (CPET) is considered the gold standard for assessing exercise tolerance, with O<sub>2</sub>-pulse commonly used as a surrogate for stroke volume (SV). However, because SV reduction can be masked by increased oxygen extraction, direct non-invasive measurement of SV is valuable. This study involved 102 HCM patients (mean age 53 ± 16 years, 78% male), predominantly with a non-obstructive phenotype (74%), who underwent CPET with SV measurement using Physioflow (PF). Abnormal O<sub>2</sub>-pulse kinetics were observed in 12 patients, all confirmed by abnormal SV trends with PF. Additionally, PF identified another 28 patients with altered SV kinetics. Abnormal SV trends were associated with higher peak VE/VO<sub>2</sub> ratios (42.6 [37.4–47.5] vs. 38.0 [33.6–41.3]) and lower end-tidal CO<sub>2</sub> values (31.8 ± 4.9 vs. 34.3 ± 5.6 mmHg, <i>p</i> &lt; 0.05). Patients with greater SV growth during the final 25% of exercise showed improved anaerobic threshold VO<sub>2</sub> (49.8 ± 12.3% vs. 43.9 ± 15.2% predicted peak VO<sub>2</sub>), VO<sub>2</sub>/work slope (10.2 ± 2.0 vs. 9.3 ± 1.3 mL/min/Watt), and peak PetCO<sub>2</sub> (34.5 ± 5.6 vs. 32.3 ± 5.2 mmHg), alongside a lower VE/VCO<sub>2</sub> slope (28.7 [24.9–31.0] vs. 31.3 [27.3–34.2], <i>p</i> &lt; 0.05). Integrating PF and CPET may enhance the detection of abnormal SV kinetics, which are associated with reduced functional capacity in HCM patients.</p>

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Non-invasive stroke volume assessment during cardiopulmonary exercise testing provides additional insight beyond O2-pulse in hypertrophic cardiomyopathy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月17日

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  • Massimo Mapelli,
  • Nikita Baracchini,
  • Nicola Campana,
  • Teresa Maria Capovilla,
  • Alessandro Nava,
  • Elisabetta Salvioni,
  • Carlo Vignati,
  • Filippo Maria Rubbo,
  • Damiano Magrì,
  • Beatrice Pezzuto,
  • Irene Mattavelli,
  • Nicolò Capra,
  • Simona Costantino,
  • Fiorella Puttini,
  • Cosimo Carriere,
  • Irena Tavčar,
  • Maddalena Rossi,
  • Christian Cadeddu Dessalvi,
  • Robin Willixhofer,
  • Marco Merlo,
  • Gianfranco Sinagra,
  • Piergiuseppe Agostoni

摘要

In hypertrophic cardiomyopathy (HCM), cardiopulmonary exercise testing (CPET) is considered the gold standard for assessing exercise tolerance, with O2-pulse commonly used as a surrogate for stroke volume (SV). However, because SV reduction can be masked by increased oxygen extraction, direct non-invasive measurement of SV is valuable. This study involved 102 HCM patients (mean age 53 ± 16 years, 78% male), predominantly with a non-obstructive phenotype (74%), who underwent CPET with SV measurement using Physioflow (PF). Abnormal O2-pulse kinetics were observed in 12 patients, all confirmed by abnormal SV trends with PF. Additionally, PF identified another 28 patients with altered SV kinetics. Abnormal SV trends were associated with higher peak VE/VO2 ratios (42.6 [37.4–47.5] vs. 38.0 [33.6–41.3]) and lower end-tidal CO2 values (31.8 ± 4.9 vs. 34.3 ± 5.6 mmHg, p < 0.05). Patients with greater SV growth during the final 25% of exercise showed improved anaerobic threshold VO2 (49.8 ± 12.3% vs. 43.9 ± 15.2% predicted peak VO2), VO2/work slope (10.2 ± 2.0 vs. 9.3 ± 1.3 mL/min/Watt), and peak PetCO2 (34.5 ± 5.6 vs. 32.3 ± 5.2 mmHg), alongside a lower VE/VCO2 slope (28.7 [24.9–31.0] vs. 31.3 [27.3–34.2], p < 0.05). Integrating PF and CPET may enhance the detection of abnormal SV kinetics, which are associated with reduced functional capacity in HCM patients.