{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T04:10:08Z","timestamp":1785816608476,"version":"3.56.0"},"reference-count":33,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T00:00:00Z","timestamp":1754524800000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100018430","name":"Fondazione Istituto Europeo di Oncologia e Centro Cardiologico Monzino","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100018430","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Career Development Fellowship"},{"name":"R.W."},{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"publisher","award":["B43C24000090001"],"award-info":[{"award-number":["B43C24000090001"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]},{"name":"P.A"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Hypertrophic cardiomyopathy (HCM) is associated with functional limitations during exercise. We aimed to evaluate oxygen pulse (O2p) as a stroke volume (SV) surrogate and to propose a new HCM classification (RoMa) based on haemodynamic profiles during exercise: predicted peak O2p (O2pp) and peak heart rate (HRpp).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>This multicentre, prospective study included 90 clinically stable HCM patients who underwent cardiopulmonary exercise testing with simultaneous impedance cardiography (PhysioFlow\u00ae). We assessed the relationship between SV and O2p. Patients were stratified into four groups based on HRpp (\u226580% predicted) and O2pp (\u2265100% predicted): RoMa I (high HRpp\u2013high O2pp), RoMa II (high HRpp\u2013low O2pp), RoMa III (low HRpp\u2013high O2pp), and RoMa IV (low HRpp\u2013low O2pp). Oxygen uptake (VO2), minute ventilation-to-carbon dioxide production (VE\/VCO2) slope, SV, and mitral regurgitation (MR) were analysed. Patients (80% male, 53 [42\u201364] years) had preserved left ventricular ejection fraction (62 [58\u201368]%) and peakVO2 (23.1 \u00b1 7.8\u2005mL\/min\/kg = 81 \u00b1 21% predicted). SV correlated with O2p (r = 0.48, P &amp;lt; 0.001; \u03b2 = 3.59, P &amp;lt; 0.001). Resting moderate to severe MR was more prevalent in RoMa class IV (41%) vs. RoMa I (18%, P = 0.038). PeakVO2 declined across groups, from 29.7 \u00b1 8.3 (RoMa I) to 16.2 \u00b1 5.1\u2005mL\/min\/kg (RoMa IV, P &amp;lt; 0.001). VE\/VCO2 slope increased from 26.4 \u00b1 4.5 (RoMa I) to 38.6 \u00b1 6.0 (RoMa IV, P = 0.002). Peak SV decreased from 128.7 \u00b1 24.8 (RoMa I) to 104.7 \u00b1 28.0\u2005mL (RoMa IV, P = 0.019), while rest to peak SV difference dropped from 38.6 (30.4\u201352.8) to 15.8 (8.2\u201327.9)\u2005mL (P = 0.002).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>SV and O2p are significantly related, and the RoMa classification effectively distinguished HCM patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Key Findings<\/jats:title>\n                  <jats:p>O2p is a reliable indicator of SV, helping to better understand exercise limitations in HCM patients.<\/jats:p>\n                  <jats:p>The newly introduced RoMa classification effectively distinguishes different levels of exercise impairment in HCM, linking poorer heart function to lower oxygen uptake and higher breathing inefficiency.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwaf402","type":"journal-article","created":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T20:06:40Z","timestamp":1755029200000},"source":"Crossref","is-referenced-by-count":8,"title":["Cardiopulmonary exercise testing in hypertrophic cardiomyopathy: the role of reduced O2 pulse and chronotropic incompetence in myocardial adaptation"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3405-5715","authenticated-orcid":false,"given":"Robin","family":"Willixhofer","sequence":"first","affiliation":[{"name":"Centro Cardiologico Monzino, IRCCS , Via Parea 4, Milan 20138 ,","place":["Italy"]},{"name":"Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan , Via della Commenda 19, Milan 20122 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Mapelli","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, IRCCS , Via Parea 4, Milan 20138 ,","place":["Italy"]},{"name":"Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan , Via della Commenda 19, Milan 20122 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikita","family":"Baracchini","sequence":"additional","affiliation":[{"name":"Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste , Via P. Valdoni 7, Trieste 34100 ,","place":["Italy"]},{"name":"Postgraduate School of Cardiovascular Medicine University of Trieste, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste , Via P. Valdoni 7, Trieste 34100 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6876-5083","authenticated-orcid":false,"given":"Nicola","family":"Campana","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, IRCCS , Via Parea 4, Milan 20138 ,","place":["Italy"]},{"name":"Department of Medical Sciences and Public Health, Cardiology Unit, University Hospital Duilio Casula\u2014Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari , Cagliari ,","place":["Italy"]},{"name":"Cardiology Division, Sirai Hospital , Carbonia, SU ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa Maria","family":"Capovilla","sequence":"additional","affiliation":[{"name":"Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste , Via P. Valdoni 7, Trieste 34100 ,","place":["Italy"]},{"name":"Postgraduate School of Cardiovascular Medicine University of Trieste, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste , Via P. Valdoni 7, Trieste 34100 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Nava","sequence":"additional","affiliation":[{"name":"Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste , Trieste ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta","family":"Salvioni","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, IRCCS , Via Parea 4, Milan 20138 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8235-9353","authenticated-orcid":false,"given":"Carlo","family":"Vignati","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, IRCCS , Via Parea 4, Milan 20138 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo Maria","family":"Rubbo","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, IRCCS , Via Parea 4, Milan 20138 ,","place":["Italy"]},{"name":"Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste , Via P. Valdoni 7, Trieste 34100 ,","place":["Italy"]},{"name":"Postgraduate School of Cardiovascular Medicine University of Trieste, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste , Via P. Valdoni 7, Trieste 34100 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damiano","family":"Magr\u00ec","sequence":"additional","affiliation":[{"name":"Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant\u2019Andrea, Universit\u00e0 degli Studi di Roma \u2018La Sapienza\u2019 , Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Pezzuto","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, IRCCS , Via Parea 4, Milan 20138 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Mattavelli","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, IRCCS , Via Parea 4, Milan 20138 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Apostolo","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, IRCCS , Via Parea 4, Milan 20138 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Palermo","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, IRCCS , Via Parea 4, Milan 20138 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2276-9630","authenticated-orcid":false,"given":"Jeness","family":"Campodonico","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, IRCCS , Via Parea 4, Milan 20138 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Contini","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, IRCCS , Via Parea 4, Milan 20138 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Costantino","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, IRCCS , Via Parea 4, Milan 20138 ,","place":["Italy"]},{"name":"Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan , Via della Commenda 19, Milan 20122 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cosimo","family":"Carriere","sequence":"additional","affiliation":[{"name":"Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste , Via P. 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