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Exercise Training in HCM Patients Without LVOT Obstruction
Quick Takes
- A 12-week supervised moderate-intensity exercise training intervention reduced the primary endpoint of LV filling pressure at mild exercise.
- Furthermore, exercise training improved exercise performance and ventilatory efficiency and reduced self-perceived physical limitations.
- It appears that implementing an exercise training program tailored for patients with HCM without LVOT obstruction may benefit such patients by improving central hemodynamic parameters, potentially mitigating cardiopulmonary disease progression.
Study Questions:
What is the effect of exercise training on left ventricular (LV) filling pressure measured during exercise in patients with hypertrophic cardiomyopathy (HCM) without left ventricular outflow tract (LVOT) obstruction?
Methods:
The investigators randomly assigned patients with HCM without LVOT obstruction (1:1) to a 12-week (3 hours/week) supervised, moderate-intensity exercise training program or continued usual activity. The primary outcome was the change in invasively measured pulmonary capillary wedge pressure (PCWP) during mild exercise (25 W) from baseline to week 12. Pressure tracings were analyzed offline by a blinded investigator. Secondary outcomes included changes in peak oxygen consumption, cardiac index, quality of life, echocardiographic indices of diastolic function, and natriuretic peptides. Between-group differences of changes from baseline to follow-up were assessed by the intention-to-treat principle. The primary analysis was a two-sided t-test of the change in PCWP (measured at 25 W) from baseline to follow-up in the modified intention-to-treat cohort (all patients with data available at follow-up regardless of adherence).
Results:
Of 59 patients randomized (mean age, 58.1 ± 12.2 years; 27% women), 51 (86%) completed all follow-up assessments. At week 12, the change in 25-W PCWP was -2.8 ± 6.8 mm Hg in the exercise group, compared with +1.2 ± 4.9 mm Hg in the usual-activity group (between-group difference, 4.0 mm Hg [95% CI, 0.7-7.3]; p = 0.018). Peak oxygen consumption improved by +1.8 ± 2.0 mL/kg/min in the exercise group versus -0.3 ± 3.1 mL/kg/min in the usual-activity group (p = 0.005). Exercise training improved the ventilatory efficiency (VE/VCO2) slope compared with usual activity (between-group difference, 2.0 [95% CI, 0.6-3.5]; p = 0.006). Peak cardiac index improved by +0.38 ± 1.38 L/min/m2 in exercise versus -0.85 ± 1.20 L/min/m2 in the usual-activity group (p = 0.002). Change in overall Kansas City Cardiomyopathy Questionnaire score was similar between groups. However, the change in physical limitation scores (+8.4 ± 12.0 points in exercise vs. +0.7 ± 6.8 points in usual-activity group; p = 0.034) and quality-of-life scores (+8.7 ± 18.0 points in exercise vs. 0.7 ± 4.0 points in usual-activity group; p = 0.01) differed significantly. There were no significant changes in diastolic function assessed by echocardiography or in natriuretic peptides.
Conclusions:
The authors report that in patients with HCM without LVOT obstruction, a 12-week moderate-intensity exercise training program resulted in reduced LV filling pressures at mild exertion and improved exercise performance.
Perspective:
This trial reports that a 12-week supervised moderate-intensity exercise training intervention reduced the primary endpoint of LV filling pressure at 25 W exercise. Furthermore, exercise training improved exercise performance and ventilatory efficiency and reduced self-perceived physical limitations. Although the current study was not specifically designed to evaluate safety outcomes, the findings nonetheless support the safety of exercise in this population. It appears that implementing an exercise training program tailored for patients with HCM without LVOT obstruction may benefit such patients by improving central hemodynamic parameters, potentially mitigating cardiopulmonary disease progression. Accordingly, it may serve as a valuable complement to conventional management strategies for this patient cohort.
Clinical Topics: Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Exercise
Keywords: Cardiomyopathy, Hypertrophic, Exercise, Quality of Life
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