BACKGROUND Patients with hypertrophic cardiomyopathy without left ventricular outflow tract obstruction commonly experience reduced exercise capacity. Physical training improves exercise capacity in these patients, but whether the underlying effects of exercise are a result of central hemodynamic or peripheral improvement is unclear. This study assessed whether exercise training reduces left ventricular filling pressure measured during exercise in patients with hypertrophic cardiomyopathy without left ventricular outflow tract obstruction. METHODS Between March 2019 and June 2022, patients with hypertrophic cardiomyopathy without left ventricular outflow tract obstruction were randomly assigned (1:1) to a 12-week (3 h/wk) supervised, moderate-intensity exercise training program or continued usual activity. The primary outcome was the change in invasively measured pulmonary capillary wedge pressure 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. 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 pulmonary capillary wedge pressure 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 versus +0.7±6.8 points in usual-activity group; P=0.034) and quality-of-life scores (+8.7±18.0 points in exercise versus 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 In patients with hypertrophic cardiomyopathy without left ventricular outflow tract obstruction, a 12-week moderate-intensity exercise training program resulted in reduced left ventricular filling pressures at mild exertion and improved exercise performance. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03537183.

中文翻译：

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无左心室流出道梗阻的肥厚型心肌病患者的运动训练：一项随机临床试验。


背景 无左心室流出道梗阻的肥厚型心肌病患者通常表现为运动能力下降。体育锻炼可以提高这些患者的运动能力，但运动的潜在影响是中枢血流动力学还是外周血流改善的结果尚不清楚。本研究评估了运动训练是否能降低无左心室流出道梗阻的肥厚型心肌病患者在运动期间测得的左心室充盈压。方法 在 2019 年 3 月至 2022 年 6 月期间，无左心室流出道梗阻的肥厚型心肌病患者被随机分配 （1：1） 接受为期 12 周 （3 h/wk） 的监督、中等强度运动训练计划或继续正常活动。主要结局是轻度运动期间有创测量的肺毛细血管楔压 （25 W） 从基线到第 12 周的变化。压力追踪由盲法调查员离线分析。次要结局包括峰值耗氧量、心脏指数、生活质量、舒张功能超声心动图指数和利钠肽的变化。结果 在 59 例随机分配的患者中 （平均年龄 58.1±12.2 岁;27% 为女性），51 例 （86%） 完成了所有随访评估。第 12 周时，运动组 25 W 肺毛细血管楔压的变化为 -2.8±6.8 mm Hg，而常规活动组为 +1.2±4.9 mm Hg（组间差异，4.0 mm Hg [95% CI，0.7-7.3];P=0.018）。运动组的峰值耗氧量提高了 +1.8±2.0 mL/kg/min，而常规活动组为 -0.3±3.1 mL/kg/min （P=0.005）。 与常规活动相比，运动训练改善了通气效率 （VE/VCO2） 斜率 （组间差异，2.0 [95% CI，0.6-3.5];P=0.006）。运动时心脏峰值指数提高了 +0.38±1.38 L/min/m2，而正常活动组为 -0.85±1.20 L/min/m2 （P=0.002）。堪萨斯城心肌病问卷总体评分的变化在两组之间相似。然而，运动中的身体限制评分变化 （+8.4±12.0 分，而日常活动组为 +0.7±6.8 分;P=0.034）和生活质量评分 （+8.7±18.0 分 vs 正常活动组 0.7±4.0 分;P=0.01） 差异显著。超声心动图或利钠肽评估的舒张功能没有显着变化。结论 在无左心室流出道梗阻的肥厚型心肌病患者中，为期 12 周的中等强度运动训练计划导致轻度运动时左心室充盈压降低，运动表现改善。注册网址：https://www.clinicaltrials.gov;唯一标识符：NCT03537183。