Lin Y; Department of Ultrasound, Fujian Medical University, Longyan, China.
Hou S; Lin J; Zhang T et al

Cardiology. 151(4):458-470, 2026. VI 1

Introduction: This study aims to assess left ventricular (LV) function and
exercise endurance in patients with hypertrophic cardiomyopathy (HCM)
using a combination of left ventricular pressure-strain loop (LV-PSL) and
cardiopulmonary exercise testing (CPET) and to explore the correlation of
the maximum left ventricular wall thickness (MWT) with clinical,
echocardiographic, and CPET parameters.

METHODS: A total of 55 patients with nonobstructive HCM, diagnosed
between January 2022 and March 2023 at Longyan First Affiliated Hospital
of Fujian Medical University, were included, along with 55 healthy
volunteers as a control group. Two-dimensional ultrasound speckle tracking
technology was used to obtain global longitudinal strain (GLS),
longitudinal strain peak time dispersion (PSD), as well as the myocardial
global work index (GWI), myocardial global constructive work (GCW), global
wasted work (GWW), and global work efficiency (GWE). The differences in
these parameters were compared between the two groups before and after
CPET. CPET was used to measure peak oxygen consumption (Peak VO2),
anaerobic threshold (AT), ventilation equivalent for carbon dioxide slope
(VE/VCO2 slope), oxygen pulse (VO2/HR), and metabolic equivalents (METs),
and the differences between the two groups were also compared.

RESULTS: Compared to the control group, the HCM group showed significant
reductions in GLS, GWI, GCW, and GWE, while GWW and PSD were significantly
increased, with statistical significance (p < 0.05). Peak VO2, AT, VO2/HR,
and METs were significantly lower in the HCM group compared to the control
group, while VE/VCO2 slope did not show a significant increase (p > 0.05).
CPET, GWI, and GCW did not increase significantly in the HCM group (p >
0.05), whereas GWW and PSD showed significant increases (p < 0.05). In
contrast, in the control group, GWI and GCW increased significantly after
CPET (p < 0.05), and no significant changes were observed in GWW and PSD
(p > 0.05). Univariable linear regression analysis showed that MWT was
correlated with NYHA class, GLS, PSD, GCW, GWW, Peak VO2, and AT (p <
0.05). Multivariate linear regression analysis confirmed the independent
associations of MWT with PSD, GCW, and GWW (p < 0.05).

CONCLUSION: LV-PSL combined with CPET is effective in early detection of
LV function and exercise endurance impairment in HCM