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. 1998 Jul;80(1):60–67. doi: 10.1136/hrt.80.1.60

Cardiopulmonary responses to exercise in patients with hypertrophic cardiomyopathy

S Jones 1, P Elliott 1, S Sharma 1, W McKenna 1, B Whipp 1
PMCID: PMC1728747  PMID: 9764062

Abstract

Objective—To examine the submaximal and maximal indices of the exercise response of patients with hypertrophic cardiomyopathy.
Design and setting—Prospective examination of cardiopulmonary responses to ramp exercise test of a consecutive group of patients with hypertrophic cardiomyopathy attending a cardiomyopathy outpatient clinic.
Methods—50 patients aged 12 to 76 years (mean (SD) 35 (14)) with diagnosis of hypertrophic cardiomyopathy performed incremental cycle ergometry; 22 sedentary volunteers (seven female, 15 male) aged 14 to 58 years (mean (SD) 31 (12)) served as controls. Respiratory gas was continuously sampled from the mouthpiece, and its concentration profile phase aligned to the respired air flow signals. Following analogue to digital conversion, gas exchange variables were computed breath by breath and the data were averaged every 30 seconds for graphic display. A 12 lead ECG was monitored continuously and recorded every three minutes during the exercise.
Results—Both the peak oxygen uptake attained on the test (V̇O2 peak) and anaerobic threshold were reduced in patients with hypertrophic cardiomyopathy compared with the control group (p < 0.0001). In 29 patients (59%) the V̇O2 peak was less than 60% and only two patients achieved a peak above 80% of their predicted values. The anaerobic threshold was below 60% of the predicted value in 31 patients and above 80% in only three patients. The slope of oxygen uptake/work rate relation (ΔV̇O2/ΔWR) was decreased in 16 patients (32%). The maximum oxygen pulse (V̇O2/HR) was reduced as a percentage of the predicted value, and became flat at high work rates in 32 patients. There was a significant correlation between anaerobic threshold and V̇O2 peak (p < 0.0001), work efficiency (p < 0.0001), and maximum oxygen pulse (p < 0.0001). The slope of change in ventilation against change in carbon dioxide output (ΔV̇E/ΔV̇CO2) for the subanaerobic threshold range was increased in 36 patients (72%) and was inversely correlated with anaerobic threshold (p < 0.0002).
Conclusions—There were severe abnormalities in maximal and submaximal indices of pulmonary gas exchange in a cohort of hypertrophic cardiomyopathy patients attending a referral cardiovascular clinic. The pattern of the abnormalities suggests that a reduced stroke volume response, ventilation/perfusion mismatch, and abnormal peripheral oxygen utilisation are the possible mechanisms of exercise intolerance.

 Keywords: exercise tolerance;  work efficiency;  oxygen pulse;  hypertrophic cardiomyopathy

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Figure 1  .

Figure 1  

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Profile of response of V̇CO2 (uppermost panels), ventilatory equivalent for V̇O2 and V̇CO2 (middle panels), and end tidal PO2 and end tidal PCO2 (lower panels) as a function of oxygen uptake during an incremental test to the limit of tolerance in a male control (left panels) and a patient with hypertrophic cardiomyopathy (right panels). Note the reduced anaerobic threshold in the patient.

Figure 2  .

Figure 2  

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The profile of V̇O2 response, as a function of work rate, in incremental exercise test in a control subject (left panel) and a patient with hypertrophic cardiomyopathy (HCM) (right panel). Note the reduced slope of this relation in the patient with HCM.

Figure 3  .

Figure 3  

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Profile of response of heart rate and oxygen pulse to progressively increasing work rate to limit of tolerance in a control subject (left panel) and in a patient with hypertrophic cardiomyopathy (HCM) (right panel). Note that the oxygen pulse continues to increase throughout the work rate in the control subject, whereas it reaches a plateau at some 60% of the maximum work rate in a patient with HCM. Note also the clearly discernible increase in the heart rate response at the work rate at which the oxygen pulse begins to plateau.

Figure 4  .

Figure 4  

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Profile of the ventilatory response as a function of V̇CO2 during an incremental exercise test to the limit of tolerance in a control subject (left panel) and a patient with hypertrophic cardiomyopathy (right panel). Note the high slope in the patient.

Figure 5  .

Figure 5  

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Oxygen uptake (V̇O2 ), anaerobic threshold (AT), ratio of change in oxygen uptake to work rate (ΔV̇O2/ΔWR), oxygen pulse (V̇O2 /HR), and the ratio of ventilation to carbon dioxide production (V̇E/V̇CO2 ) as a function of the left ventricular maximum wall thickness (MWT) in patients with hypertrophic cardiomyopathy.

Figure 6  .

Figure 6  

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Oxygen uptake to work rate ratio (ΔV̇O2 /ΔWR), oxygen pulse (V̇O2 /HR), and oxygen uptake (V̇O2 ), and the ratio of ventilation to carbon dioxide production (V̇E/V̇CO2 ) as a function of anaerobic threshold (AT) in patients with hypertrophic cardiomyopathy.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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