Dataset Information

Prognostic relevance of exercise testing in hypertrophic cardiomyopathy. A systematic review.

ABSTRACT:

Background

Cardiopulmonary exercise test (CPET) is indicated as part of the assessment in hypertrophic cardiomyopathy (HCM) patients and stress echocardiography is often used to assess symptoms. However, the role of exercise testing for prognostic stratification in HCM is still not established.

Aims

To systematically review the evidence on the role of exercise testing for prognostic stratification in hypertrophic cardiomyopathy.

Methods

A systematic review was conducted for eligible publications, between 2010 and 2020, that included evaluation of outcomes and prognosis. In these studies, patients underwent exercise echocardiography and/or cardiopulmonary exercise testing, performed according to predefined protocols. Diverse parameters were assessed in order to determine which were relevant for the prognosis. Analyzed outcomes included death from any cause, sudden cardiac death (SCD) and equivalents, cardiovascular death, heart failure requiring hospitalization or progression to New York Heart Association classes III or IV, cardiac transplantation, non-sustained ventricular tachycardia, stroke, myocardial infarction and invasive septal reduction therapy.

Results

Eighteen publications were included, corresponding to a total of 7525 patients. The mean follow-up period varied between 1 and 8 years. The main findings of these studies revealed that the major predictors of outcomes were abnormal heart rate recovery, abnormal blood pressure response exercise induced wall motion abnormalities, lower peak VO2, higher VE/VCO2, and pulmonary hypertension/exercise-induced pulmonary hypertension.

Conclusion

Although most studies concluded that exercise test results are useful to determine prognosis in HCM, further investigation is needed regarding whether it adds independent value to the current risk stratification strategies.

SUBMITTER: Rodrigues T

PROVIDER: S-EPMC8425182 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundHypertrophic cardiomyopathy (HCM) is recognized as the most prevalent form of genetic cardiomyopathy, and recent investigations have shed light on the existence of sex disparities in terms of clinical presentation, disease progression, and outcomes.ObjectivesThis study aimed to systematically review the literature and perform a meta-analysis to comprehensively compare the clinical outcomes between female and male patients with HCM.MethodsA thorough search was conducted in databases including PubMed, Embase, Cochrane Library, and Web of Science, encompassing literature from inception until June 2023. The primary endpoints examined were: (1) all-cause mortality; (2) an arrhythmic endpoint comprising sudden cardiac death (SCD), sustained ventricular tachycardia, ventricular fibrillation, or aborted SCD; and (3) a composite endpoint incorporating either (1) or (2), in addition to hospitalization for heart failure or cardiac transplantation. Pooled estimates were derived using a random-effects meta-analysis model.ResultsThe analysis encompassed a total of 29 observational studies, involving 44,677 patients diagnosed with HCM, of which 16,807 were female. Baseline characteristics revealed that the female group exhibited an advanced age [55.66 ± 0.04 years vs. 50.38 ± 0.03 years, pooled mean difference (MD) = 0.31, 95% CI: 0.22-0.40, p = 0.000, I2 = 88.89%], a higher proportion of New York Heart Association class III/IV patients [pooled odds ratio (OR) = 1.94, 95% CI: 1.55-2.43, p = 0.000, I2 = 85.92%], and a greater prevalence of left ventricular outflow tract gradient greater than or equal to 30 mmHg (pooled OR = 1.48, 95% CI: 1.27-1.73, p = 0.000, I2 = 68.88%) compared to the male group. The female group were more likely to have a positive genetic test (pooled OR = 1.27, 95% CI: 1.08-1.48, p = 0.000, I2 = 42.74%) and to carry the myosin heavy chain beta 7 mutation (pooled OR = 1.26, 95% CI: 1.04-1.54, p = 0.020, I2 = 0.00%) compared to the male group. Female sex exhibited a significant association with increased risks of all-cause mortality (pooled OR = 1.62, 95% CI: 1.38-1.89, p = 0.000, I2 = 72.78%) and the composite endpoint (pooled OR = 1.47, 95% CI: 1.20-1.79, p = 0.000, I2 = 84.96%), while no substantial difference was observed in the arrhythmic endpoint (pooled OR = 1.08, 95% CI: 0.87-1.34, p = 0.490, I2 = 55.48%).ConclusionsThe present findings suggest that female patients with HCM tend to experience poorer clinical outcomes. It is imperative to critically reevaluate disease definitions and enhance awareness to mitigate delays in the diagnosis and treatment of HCM in women, thereby fostering equitable healthcare practices.Systematic review registrationhttps://www.crd.york.ac.uk/, PROSPERO (CRD42023431881).