Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun 17:59:101722.
doi: 10.1016/j.ijcha.2025.101722. eCollection 2025 Aug.

Incidence of cardiovascular risk factors and exercise phenotyping in cardiomyopathies: One size does not fit all

Simon Wernhart  1   2 , Florian Karcher  1 , Mark J Haykowsky  3   4 , Martin Halle  1   2
Affiliations

Incidence of cardiovascular risk factors and exercise phenotyping in cardiomyopathies: One size does not fit all

Simon Wernhart et al. Int J Cardiol Heart Vasc. .

Abstract

Background: Cardiovascular disease risk factors (CVDRF) are linked to increased morbidity in cardiomyopathies (CMP), but whether new onset CVDRF differ among CMPs is unknown. In addition, whether the acute exercise response during cardiopulmonary exercise testing (CPET) differs among CMPs remains unclear.

Methods: This single-center, retrospective study analyzed patients with arrhythmogenic, hypertrophic, and dilated (DCM) cardiomyopathy without CVDRF at baseline. Resting echocardiography and CPET were performed, and exercise response was assessed depending on sex and CMP. After a median follow-up of 19.5 months, CPET and echocardiography were analyzed in relation to the development of new CVDRF.

Results: A total of 104 CMPs were included (median age 53.0 years). New-onset CVDRF was rare (11.5 %) and driven by arterial hypertension (8.7 %) but did not differ among CMPs. DCM displayed significantly lower resting left ventricular ejection fraction (40.5 %, interquartile range, IQR, 11.5 %, p < 0.001), diastolic function (E/e' 9.3, IQR 5.5, p < 0.001), and had the lowest peak systolic blood pressure (170.0 mmHg, IQR 52.5 mmHg, p = 0.011), predicted peak oxygen consumption (82.0 %, IQR 39.8 %, p = 0.003), oxygen pulse (101.0 %, IQR 28.8 %, p = 0.030) as well as lower ventilatory (VP, 5.5 mmHg, IQR 1.4 mmHg, p = 0.033) and circulatory (CP, 4096.0 mL/kg/min x mmHg, IQR 2299.3 mL/kg/min x mmHg, p = 0.015) power compared to the other groups. Lower VP (5.0 mmHg, IQR 1.3 mmHg, p = 0.003) and CP (3660.0 mL/kg/min x mmHg, IQR 3298.0 mL/kg/min x mmHg, p = 0.004) were observed for females.

Conclusions: Arterial hypertension was the most common CVDRF among CMPs, underscoring the importance of monitoring this outcome. Exercise limitations differ between CMPs and should be interpreted depending on sex.

Keywords: Cardiomyopathy; Cardiovascular risk factors; Circulatory limitations; Exercise blood pressure.

PubMed Disclaimer

Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [SW has received honoraria for lectures from Bristol-Myers Squibb. MHay is funded, in part, by a Research Chair in Aging in the Faculty of Nursing, College of Healthy Sciences at UofA. MH reports honoraria for lectures from Abbott, Amgen, Astra- Zeneca, Boehringer-Ingelheim, BMW, Bristol-Myers Squibb, Daiichi-Sankyo, Lilly, Medi, MSD Sharp & Dohme GmbH, Norsan, Novartis, Pfizer and Roche, consulting fees from Medical Park. No other potential conflicts of interest are reported.].

Figures

None
Graphical abstract
Fig. 1
Fig. 1
Workflow of study inclusion. Data assessment started in 01/2020. ACM: Arrhythmogenic cardiomyopathy. CPET: Cardiopulmonary exercise testing. CVDRF: Cardiovascular disease risk factor. DCM: Dilated cardiomyopathy. Echo: Transthoracic echocardiography. HCM: Hypertrophic cardiomyopathy. Sequential CPET and echo refers to both examinations being performed on the same day.
Fig. 2
Fig. 2
Group differences in blood pressure response during exercise in cardiomyopathies. ACM: Arrhythmogenic cardiomyopathy. DCM: Dilated cardiomyopathy. HCM: Hypertrophic cardiomyopathy. A: Differences between resting and peak systolic blood pressure (SBP rest to peak). B: Peak systolic blood pressure (SBP peak). C: Ratio between systolic blood pressure and oxygen consumption (SBP/VO2). D: Ratio between systolic blood pressure and workload (SBP/W). Significance is depicted with an asterisk.
Fig. 3
Fig. 3
Group differences between cardiomyopathies during cardiopulmonary exercise testing. ACM: Arrhythmogenic cardiomyopathy. DCM: Dilated cardiomyopathy. HCM: Hypertrophic cardiomyopathy. A: A: Percentage of predicted peak oxygen consumption (% of predicted VO2peak), reference values are derived from the SHIP database [18]. B: Percentage of peak oxygen consumption at the first ventilatory threshold (% of VO2peak at VT1). C: Circulatory power (ratio of peak systolic pressure and peak oxygen consumption). D: Ventilatory power (ratio between peak oxygen consumption and minute ventilation per carbon dioxide production). Significance is depicted with an asterisk.
Fig. 4
Fig. 4
Sex-dependent exercise blood pressure response in cardiomyopathies. A: Differences between resting and peak systolic blood pressure (SBP rest to peak). B: Peak systolic blood pressure (SBP peak). C: Ratio between systolic blood pressure and oxygen consumption (SBP/VO2). D: Ratio between systolic blood pressure and workload (SBP/W). Significance is depicted with an asterisk.
Fig. 5
Fig. 5
Sex-dependent performance during exercise testing in cardiomyopathies. A: Percentage of predicted peak oxygen consumption (% of predicted VO2peak), reference values are derived from the SHIP database [18]. B: Percentage of peak oxygen consumption at the first ventilatory threshold (% of VO2peak at VT1). C: Circulatory power (ratio of peak systolic pressure and peak oxygen consumption). D: Ventilatory power (ratio between peak oxygen consumption and minute ventilation per carbon dioxide production). Significance is depicted with an asterisk.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Arbelo E., Protonotarios A., Gimeno J.R., Arbustini E., Barriales-Villa R., Basso C., et al. 2023 ESC guidelines for the management of cardiomyopathies. Eur. Heart J. 2023;44:3503–3626. - PubMed
    1. Ommen S.R., Ho C.Y., Asif I.M., Balaji S., Burke M.A., Day S.M., et al. 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR guideline for the Management of Hypertrophic Cardiomyopathy: a report of the American Heart Association/American College of Cardiology Joint Committee on clinical Practice guidelines. Circulation. 2024;149:e1239–e1311. - PubMed
    1. Guazzi M., Wilhelm M., Halle M., Van Craenenbroeck E., Kemps H., de Boer R.A., et al. Exercise testing in heart failure with preserved ejection fraction: an appraisal through diagnosis, pathophysiology and therapy - A clinical consensus statement of the Heart failure association and European Association of Preventive Cardiology of the European Society of Cardiology. Eur. J. Heart Fail. 2022;24:1327–1345. - PMC - PubMed
    1. Ribeiro G.D.S., Deresz L.F., Salvioni E., Hansen D., Agostoni P., Karsten M. Sensitivity and specificity of different exercise oscillatory ventilation definitions to predict 2-year major adverse cardiovascular outcomes in chronic heart failure patients. Int. J. Cardiol. 2022;360:39–43. - PubMed
    1. Buber J., Robertson H.T. Cardiopulmonary exercise testing for heart failure: pathophysiology and predictive markers. Heart. 2023;109:256–263. - PubMed

LinkOut - more resources