Functional assessment of patients with hypertrophic cardiomyopathy by maximal oxygen consumption]

Introduction and objectives. Differences between anatomical severity and clinical manifestations are frequent in patients with hypertrophic cardiomyopathy. Our objective was to assess functional capacity in a consecutive group of patients with hypertrophic cardiomyopathy measuring exercise aerobic parameters, as well as clinical and echocardiographic variables. Patients and method. We studied 98 consecutive patients with hypertrophic cardiomyopathy. All patients underwent both echocardiographic and cardiopulmonary exercise testing. The control group consisted of 22 untrained persons. We studied exercise capacity by analyzing maximal oxygen consumption and aerobic functional capacity, among other variables. Results. Patients with hypertrophic cardiomyopathy attained significantly lower maximal oxygen consumption values than controls (24.1 +/- 5.9 vs 36.4 +/- 5.9 ml/kg/min; p = 0.0001). Maximal aerobic capacity was significantly different among patients with NYHA functional capacity class 1, 11 or 111 (78.9 +/- 13.5%; 71.9 +/- 14.7%; 63.9 +/- 15.7%; p = 0.009). However, considerable overlap was found between groups in maximal aerobic capacity. Functional impairment was greater in patients with left ventricular thickness >20 mm, ejection fraction <50%, left atrial dimension >45 mm and pseudonormal or restrictive transmitral flow pattern. Conclusions. Patients with hypertrophic cardiomyopathy show significant functional impairment, which is difficult to detect from their clinical manifestations. Optimal assessment requires cardiopulmonary exercise testing.