Prognostic utility of metabolic exercise testing in minimally symptomatic patients with obstructive hypertrophic cardiomyopathy

Patients with obstructive hypertrophic cardiomyopathy (HC) are at increased risk of death or severe symptoms. Although metabolic exercise testing is routinely used in the evaluation of a variety of cardiac diseases, data on the prognostic information that can be derived from such testing in HC is lacking. We examined 182 patients (mean age 53 ± 15 years; 65% men) with obstructive HC and minimal or no cardiovascular symptoms. Each patient underwent maximum exercise testing with simultaneous metabolic gas exchange measurement. Follow-up (mean 4.0 ± 3.0 years; 100% complete) was performed to determine the vital status and occurrence of severe symptoms, defined as class III or IV symptoms of dyspnea or angina. Multiple parameters of metabolic exercise were associated with a risk of death and the development of severe symptoms. On multivariate analyses, the independent predictors of death and severe symptoms were the severity of the left ventricular outflow tract gradient at rest and the percentage of predicted peak myocardial oxygen consumption achieved during exercise. For patients with a percentage of predicted peak myocardial oxygen consumption of <60%, the 4-year survival rate free of death and severe symptoms was only 59%. In conclusion, among patients with obstructive HC and mild or no symptoms, a low metabolic exercise capacity is associated with an increased risk of death and the subsequent development of severe symptoms.