Cardiopulmonary exercise test and sudden cardiac death risk in hypertrophic cardiomyopathy

Damiano Magrì, Giuseppe Limongelli, Federica Re, Piergiuseppe Agostoni, E. Zachara, Michele Correale, Vittoria Mastromarino, Caterina Santolamazza, Matteo Casenghi, Giuseppe Pacileo, Fabio Valente, Beatrice Musumeci, Antonello Maruotti, Massimo Volpe, Camillo Autore

Research output: Contribution to journalArticle

Abstract

Background In hypertrophic cardiomyopathy (HCM), most of the factors associated with the risk of sudden cardiac death (SCD) are also involved in the pathophysiology of exercise limitation. The present multicentre study investigated possible ability of cardiopulmonary exercise test in improving contemporary strategies for SCD risk stratification. Methods A total of 623 consecutive outpatients with HCM, from five tertiary Italian HCM centres, were recruited and prospectively followed, between September 2007 and April 2015. The study composite end point was SCD, aborted SCD and appropriate implantable cardioverter defibrillator (ICD) interventions. Results During a median follow-up of 3.7 years (25th- 75th centile: 2.2-5.1 years), 25 patients reached the end point at 5 years (3 SCD, 4 aborted SCD, 18 appropriate ICD interventions). At multivariate analysis, ventilation versus carbon dioxide relation during exercise (VE/VCO2 slope) remains independently associated to the study end point either when challenged with the 2011 American College of Cardiology Foundation/American Heart Association guidelines-derived score (C index 0.748) or with the 2014 European Society of Cardiology guidelines-derived score (C index 0.750). A VE/VCO2 slope cut-offvalue of 31 showed the best accuracy in predicting the SCD end point within the entire HCM study cohort (sensitivity 64%, specificity 72%, area under the curve 0.72). Conclusions Our data suggest that the VE/VCO2 slope might improve SCD risk stratification, particularly in those HCM categories classified at low-intermediate SCD risk according to contemporary guidelines. There is a need for further larger studies, possibly on independent cohorts, to confirm our preliminary findings.

Original languageEnglish
JournalHeart
DOIs
Publication statusAccepted/In press - Feb 5 2016

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Hypertrophic Cardiomyopathy
Sudden Cardiac Death
Exercise Test
Implantable Defibrillators
Guidelines
Exercise
Carbon Dioxide
Multicenter Studies
Area Under Curve
Cohort Studies
Outpatients
Multivariate Analysis
Sensitivity and Specificity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Magrì, D., Limongelli, G., Re, F., Agostoni, P., Zachara, E., Correale, M., ... Autore, C. (Accepted/In press). Cardiopulmonary exercise test and sudden cardiac death risk in hypertrophic cardiomyopathy. Heart. https://doi.org/10.1136/heartjnl-2015-308453

Cardiopulmonary exercise test and sudden cardiac death risk in hypertrophic cardiomyopathy. / Magrì, Damiano; Limongelli, Giuseppe; Re, Federica; Agostoni, Piergiuseppe; Zachara, E.; Correale, Michele; Mastromarino, Vittoria; Santolamazza, Caterina; Casenghi, Matteo; Pacileo, Giuseppe; Valente, Fabio; Musumeci, Beatrice; Maruotti, Antonello; Volpe, Massimo; Autore, Camillo.

In: Heart, 05.02.2016.

Research output: Contribution to journalArticle

Magrì, D, Limongelli, G, Re, F, Agostoni, P, Zachara, E, Correale, M, Mastromarino, V, Santolamazza, C, Casenghi, M, Pacileo, G, Valente, F, Musumeci, B, Maruotti, A, Volpe, M & Autore, C 2016, 'Cardiopulmonary exercise test and sudden cardiac death risk in hypertrophic cardiomyopathy', Heart. https://doi.org/10.1136/heartjnl-2015-308453
Magrì, Damiano ; Limongelli, Giuseppe ; Re, Federica ; Agostoni, Piergiuseppe ; Zachara, E. ; Correale, Michele ; Mastromarino, Vittoria ; Santolamazza, Caterina ; Casenghi, Matteo ; Pacileo, Giuseppe ; Valente, Fabio ; Musumeci, Beatrice ; Maruotti, Antonello ; Volpe, Massimo ; Autore, Camillo. / Cardiopulmonary exercise test and sudden cardiac death risk in hypertrophic cardiomyopathy. In: Heart. 2016.
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AU - Magrì, Damiano

AU - Limongelli, Giuseppe

AU - Re, Federica

AU - Agostoni, Piergiuseppe

AU - Zachara, E.

AU - Correale, Michele

AU - Mastromarino, Vittoria

AU - Santolamazza, Caterina

AU - Casenghi, Matteo

AU - Pacileo, Giuseppe

AU - Valente, Fabio

AU - Musumeci, Beatrice

AU - Maruotti, Antonello

AU - Volpe, Massimo

AU - Autore, Camillo

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N2 - Background In hypertrophic cardiomyopathy (HCM), most of the factors associated with the risk of sudden cardiac death (SCD) are also involved in the pathophysiology of exercise limitation. The present multicentre study investigated possible ability of cardiopulmonary exercise test in improving contemporary strategies for SCD risk stratification. Methods A total of 623 consecutive outpatients with HCM, from five tertiary Italian HCM centres, were recruited and prospectively followed, between September 2007 and April 2015. The study composite end point was SCD, aborted SCD and appropriate implantable cardioverter defibrillator (ICD) interventions. Results During a median follow-up of 3.7 years (25th- 75th centile: 2.2-5.1 years), 25 patients reached the end point at 5 years (3 SCD, 4 aborted SCD, 18 appropriate ICD interventions). At multivariate analysis, ventilation versus carbon dioxide relation during exercise (VE/VCO2 slope) remains independently associated to the study end point either when challenged with the 2011 American College of Cardiology Foundation/American Heart Association guidelines-derived score (C index 0.748) or with the 2014 European Society of Cardiology guidelines-derived score (C index 0.750). A VE/VCO2 slope cut-offvalue of 31 showed the best accuracy in predicting the SCD end point within the entire HCM study cohort (sensitivity 64%, specificity 72%, area under the curve 0.72). Conclusions Our data suggest that the VE/VCO2 slope might improve SCD risk stratification, particularly in those HCM categories classified at low-intermediate SCD risk according to contemporary guidelines. There is a need for further larger studies, possibly on independent cohorts, to confirm our preliminary findings.

AB - Background In hypertrophic cardiomyopathy (HCM), most of the factors associated with the risk of sudden cardiac death (SCD) are also involved in the pathophysiology of exercise limitation. The present multicentre study investigated possible ability of cardiopulmonary exercise test in improving contemporary strategies for SCD risk stratification. Methods A total of 623 consecutive outpatients with HCM, from five tertiary Italian HCM centres, were recruited and prospectively followed, between September 2007 and April 2015. The study composite end point was SCD, aborted SCD and appropriate implantable cardioverter defibrillator (ICD) interventions. Results During a median follow-up of 3.7 years (25th- 75th centile: 2.2-5.1 years), 25 patients reached the end point at 5 years (3 SCD, 4 aborted SCD, 18 appropriate ICD interventions). At multivariate analysis, ventilation versus carbon dioxide relation during exercise (VE/VCO2 slope) remains independently associated to the study end point either when challenged with the 2011 American College of Cardiology Foundation/American Heart Association guidelines-derived score (C index 0.748) or with the 2014 European Society of Cardiology guidelines-derived score (C index 0.750). A VE/VCO2 slope cut-offvalue of 31 showed the best accuracy in predicting the SCD end point within the entire HCM study cohort (sensitivity 64%, specificity 72%, area under the curve 0.72). Conclusions Our data suggest that the VE/VCO2 slope might improve SCD risk stratification, particularly in those HCM categories classified at low-intermediate SCD risk according to contemporary guidelines. There is a need for further larger studies, possibly on independent cohorts, to confirm our preliminary findings.

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