Differential exercise blood pressure response in patients with hypertrophic, non-obstructive cardiomyopathy compared to patients with heart failure and preserved ejection fraction
Bibliographic record
Abstract
Abstract Background Exercise blood pressure response is not well characterized in patients with left ventricular hypertrophy, such as in patients with heart failure and preserved ejection fraction (HFpEF) or hypertrophic, non-obstructive cardiomyopathy (HCM). Peak systolic blood pressure (SBPpeak) or increase of systolic blood pressure from rest to peak exercise (SBPsupine-to peak) may be used to risk stratify patients. However, SBPpeak depends on cardiac output (CO), which is not measured routinely during exercise testing: Relating the slope of SBP to workload during exercise may better reflect adequate peripheral adaptations to exercise. While SBP/W>0.53mmHg/W has been associated with increased mortality in HFpEF, the prognostic utility of SBP/W in HCM remains unknown. Purpose To evaluate blood pressure response during exercise in relation to workload in HFpEF and HCM patients and assess its prognostic utility. Methods This is a retrospective, single-centre analysis of clinically stable HFpEF and HCM patients and a left ventricular ejection fraction ≥50% without previous rhythmogenic events. Patients reported to our outpatient clinic for elective, exertional bicycle ergometry testing and were followed-up for 4 years. Hospitalizations and cardiovascular events were assessed from the beginning to the end of the study period. Differences between SBPpeak, SBPsupine-to peak as well as SBP/W slope were compared between HCM and HFpEF patients with a level of significance of α = 0.05. Results A total of 52 patients were included (HCM: n=21, 5 females. HFpEF: n=31, 18 females, p<.001 for age). HFpEF patients were significantly older (mean age 71.8+/−18.0 years vs. 53.7+/−17.9 years, p<.001) and showed lower overall performance (132.4+/− 63.8W vs. 271.6+/−81.6W, p<.001). Hypertension at rest (HCM: n=10, HFpEF: n=20; p=0.391) and BMI (HCM: 25.0 +/− 2.7kg/m2, HFpEF: 25.7 +/− 6.6kg/m2, p=0.238) did not differ between groups. SBPpeak (207.6+/−26.5 mmHg vs. 181.7+/− 32.1mmHg, p=0.001) and SBPsupine-to peak (76.0+/−23.8 mmHg vs. 50.6+/− 25.0mmHg, p=0.001) were higher in HCM compared to HFpEF. SBP/W (0.7+/− 0.3mmHg/W vs. 0.6+/− 0.3mmHg/W, p=0.321) did not differ between HCM and HFpEF patients. In 3 out of 4 hospitalized HFpEF patients SBP/W slope was elevated (0.8, 1.0, and 1.1mmHg/W), while SBPpeak (140, 190, 200mmHg) and SBPsupine-to peak (40, 70, 80mmHg) were reduced or within normal range. Despite higher SBPpeak and SBPsupine-to peak in HCM, there were no hospitalizations or arrhythmic events. Conclusions SBP/W slope is comparable between HCM and HFpEF, but its prognostic utility in HCM remains unclear. Higher SBPpeak and SBPsupine-to peak in this young cohort of HCM patients may be the result of higher CO as a physiological response to exercise.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".