Predictors of exercise capacity in patients with hypertrophic obstructive cardiomyopathy

Joshua R. Smith, Jose R. Medina-Inojosa, Veronica Layrisse, Steve R. Ommen, Thomas P. Olson

Research output: Contribution to journalArticlepeer-review


Hypertrophic obstructive cardiomyopathy (HOCM) patients exhibit compromised peak exercise capacity (VO2 peak). Importantly, severely reduced VO2 peak is directly related to increased morbidity and mortality in these patients. Therefore, we sought to determine clinical predictors of VO2 peak in HOCM patients. HOCM patients who performed symptom-limited cardiopulmonary exercise testing between 1995 and 2016 were included for analysis. Peak VO2 was reported as absolute peak VO2, indexed to body weight and analyzed as quartiles, with quartile 1 representing the lowest VO2 peak. Step-wise regression models using demographic features and clinical and physiologic characteristics were created to determine predictors of HOCM patients with the lowest VO2 peak. We included 1177 HOCM patients (age: 53 ± 14 years; BMI: 24 ± 12 kg/m2 ) with a VO2 peak of 18.0 ± 5.6 mL/kg/min. Significant univariate predictors of the lowest VO2 peak included age, female sex, New York Health Association (NYHA) class, BMI, left atrial volume index, E/e’, E/A, hemoglobin, N-terminal pro b-type natriuretic peptide (NT-proBNP), and a history of diabetes, hypertension, stroke, atrial fibrillation, or coronary artery disease. Independent predictors of the lowest VO2 peak included age (OR, CI: 1.03, 1.02–1.06; p < 0.0001), women (4.66, 2.94–7.47; p = 0.001), a history of diabetes (2.05, 1.17–3.60; p = 0.01), BMI (0.94, 0.92–0.96; p < 0.0001), left atrial volume index (1.07, 1.05–1.21; p = 0.04), E/e’ (1.05, 1.01–1.08; p = 0.004), hemoglobin (0.76, 0.65–0.88; p = 0.0004), and NT-proBNP (1.72, 1.42–2.11; p < 0.0001). These findings demonstrate that demographic factors (i.e., age and sex), comorbidities (e.g., diabetes and obesity), echocardiography indices, and biomarkers (e.g., hemoglobin and NT-proBNP) are predictive of severely compromised VO2 peak in HOCM patients.

Original languageEnglish (US)
Article number447
JournalJournal of Clinical Medicine
Issue number11
StatePublished - Nov 18 2018


  • Exercise capacity
  • Exercise testing
  • Hypertrophic cardiomyopathy

ASJC Scopus subject areas

  • Medicine(all)


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