{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T05:34:55Z","timestamp":1788586495386,"version":"build-2803163510"},"reference-count":61,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2023,7,13]],"date-time":"2023-07-13T00:00:00Z","timestamp":1689206400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>This review emphasizes the importance of cardiopulmonary exercise testing (CPET) in patients diagnosed with hypertrophic cardiomyopathy (HCM). In contrast to standard exercise testing and stress echoes, which are limited due to the ECG changes and wall motion abnormalities that characterize this condition, CPET allows for the assessment of the complex pathophysiology and severity of the disease, its mechanisms of functional limitation, and its risk stratification. It is useful tool to evaluate the risk for sudden cardiac death and select patients for cardiac resynchronization therapy (CRT), cardiac transplantation, or mechanical circulatory support, especially when symptomatology and functional status are uncertain. It may help in differentiating HCM from other forms of cardiac hypertrophy, such as athletes\u2019 heart. Finally, it is used to guide and monitor therapy as well as for exercise prescription. It may be considered every 2 years in clinically stable patients or every year in patients with worsening symptoms. Although performed only in specialized centers, CPET combined with echocardiography (i.e., CPET imaging) and invasive CPET are more informative and provide a better assessment of cardiac functional status, left ventricular outflow tract obstruction, and diastolic dysfunction during exercise in patients with HCM.<\/jats:p>","DOI":"10.3390\/medicina59071296","type":"journal-article","created":{"date-parts":[[2023,7,14]],"date-time":"2023-07-14T00:28:06Z","timestamp":1689294486000},"page":"1296","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["The Role of Cardiopulmonary Exercise Testing in Hypertrophic Cardiomyopathy"],"prefix":"10.3390","volume":"59","author":[{"given":"Lidija","family":"Mikic","sequence":"first","affiliation":[{"name":"Division of Cardiology, Clinical and Hospital Center Zvezdara, 11120 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arsen","family":"Ristic","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3471-0946","authenticated-orcid":false,"given":"Natasa","family":"Markovic Nikolic","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Clinical and Hospital Center Zvezdara, 11120 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3758-3719","authenticated-orcid":false,"given":"Milorad","family":"Tesic","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Djordje","family":"Jakovljevic","sequence":"additional","affiliation":[{"name":"Institute for Health and Wellbeing (CSELS), Faculty of Health and Life Sciences, Coventry University, Coventry CV1 2DS, UK"},{"name":"Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle NE1 7RU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross","family":"Arena","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL 60607, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Allison","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA"},{"name":"Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dejana","family":"Popovic","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"},{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2733","DOI":"10.1093\/eurheartj\/ehu284","article-title":"ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: The Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC)","volume":"35","author":"Elliott","year":"2014","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e159","DOI":"10.1016\/j.jacc.2020.08.045","article-title":"AHA\/ACC Guideline for the Diagnosis and Treatment of Patients with Hypertrophic Cardiomyopathy: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"76","author":"Ommen","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2204","DOI":"10.1253\/circj.CJ-16-0432","article-title":"Heart Failure Progression in Hypertrophic Cardiomyopathy\u2013Possible Insights from Cardiopulmonary Exercise Testing","volume":"80","author":"Magri","year":"2016","journal-title":"Circ. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S102","DOI":"10.1513\/AnnalsATS.201611-884FR","article-title":"Cardiopulmonary exercise test in hypertrophic cardiomyopathy","volume":"14","author":"Magri","year":"2017","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2886","DOI":"10.1161\/01.CIR.92.10.2886","article-title":"Exercise capacity in hypertrophic cardiomyopathy: Role of stroke volume limitation, heart rate, and diastolic filling characteristics","volume":"92","author":"Lele","year":"1995","journal-title":"Circulation"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2232","DOI":"10.1161\/CIRCULATIONAHA.106.644682","article-title":"Hypertrophic cardiomyopathy is predominantly a disease of left ventricular outflow tract obstruction","volume":"114","author":"Maron","year":"2006","journal-title":"Circulation"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Bayonas-Ruiz, A., Munoz-Franco, F.M., Ferrer, V., P\u00e9rez-Caballero, C., Sabater-Molina, M., Tom\u00e9-Esteban, M.T., and Bonacasa, B. (2021). Cardiopulmonary Exercise Test in Patients with Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis. J. Clin. Med., 10.","DOI":"10.3390\/jcm10112312"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.1136\/hrt.2007.126003","article-title":"Prevalence of exercise-induced left ventricular outflow tract obstruction in symptomatic patients with non-obstructive hypertrophic cardiomyopathy","volume":"94","author":"Shah","year":"2008","journal-title":"Heart"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.ijcard.2010.08.026","article-title":"Chronotropic incompetence and its relation to exercise intolerance in hypertrophic cardiomyopathy","volume":"153","author":"Efthimiadis","year":"2011","journal-title":"Int. J. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3277","DOI":"10.1172\/JCI57833","article-title":"Oxidized CaMKII causes cardiac sinus node dysfunction in mice","volume":"121","author":"Swaminathan","year":"2011","journal-title":"J. Clin. Investig."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1651","DOI":"10.1016\/j.jacc.2016.07.751","article-title":"Mechanisms of myocardial ischemia in hypertrophic cardiomyopathy: Insights from wave intensity analysis and magnetic resonance","volume":"68","author":"Raphael","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1002\/ejhf.1715","article-title":"Hypertrophic cardiomyopathy: The future of treatment","volume":"22","author":"Tuohy","year":"2020","journal-title":"Eur. J. Heart Fail."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2599","DOI":"10.1093\/eurheartj\/ehp327","article-title":"Exercise-induced ventricular arrhythmias and risk of sudden cardiac death in patients with hypertrophic cardiomyopathy","volume":"30","author":"Gimeno","year":"2009","journal-title":"Eur. Heart J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2261","DOI":"10.1161\/CIR.0b013e31826fb946","article-title":"Clinical Recommendations for Cardiopulmonary Exercise Testing Data Assessment in Specific Patient Populations","volume":"126","author":"Guazzi","year":"2012","journal-title":"Circulation"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1618","DOI":"10.1016\/j.jacc.2017.08.012","article-title":"Cardiopulmonary Exercise Testing: What Is its Value?","volume":"70","author":"Guazzi","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1161\/CIRCHEARTFAILURE.114.002248","article-title":"Cardiopulmonary Exercise Testing and Prognosis in Hypertrophic Cardiomyopathy","volume":"8","author":"Coats","year":"2015","journal-title":"Circ. Heart Fail."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.amjcard.2022.11.008","article-title":"Cardiopulmonary Exercise Testing in Athletes with Hypertrophic Cardiomyopathy","volume":"189","author":"Newman","year":"2023","journal-title":"Am. J. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1001\/jamacardio.2022.5099","article-title":"Effects of Mavacamten on Measures of Cardiopulmonary Exercise Testing Beyond Peak Oxygen Consumption: A Secondary Analysis of the EXPLORER-HCM Randomized Trial","volume":"8","author":"Wheeler","year":"2023","journal-title":"JAMA Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Cui, H., Schaff, H.V., Olson, T.P., Geske, J.B., Dearani, J.A., Nishimura, R.A., Sun, D., and Ommen, S.R. (2022). Cardiopulmonary exercise test in patients with obstructive hypertrophic cardiomyopathy. J. Thorac. Cardiovasc. Surg.","DOI":"10.1016\/j.jtcvs.2022.05.025"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1161\/CIRCULATIONAHA.112.104463","article-title":"The invasive cardiopulmonary exercise test","volume":"127","author":"Maron","year":"2013","journal-title":"Circulation"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1629","DOI":"10.1136\/heartjnl-2021-320569","article-title":"Exercise oxygen pulse kinetics in patients with hypertrophic cardiomyopathy","volume":"108","author":"Mapelli","year":"2022","journal-title":"Heart"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1016\/j.ahj.2015.02.006","article-title":"Predictors of long-term outcomes in patients with hypertrophic cardiomyopathy undergoing cardiopulmonary stress testing and echocardiography","volume":"169","author":"Masri","year":"2015","journal-title":"Am. Heart J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1016\/j.jchf.2014.11.011","article-title":"Cardiopulmonary Responses and Prognosis in Hypertrophic Cardiomyopathy: A Potential Role for Comprehensive Noninvasive Hemodynamic Assessment","volume":"3","author":"Finocchiaro","year":"2015","journal-title":"JACC Heart Fail."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1494","DOI":"10.1016\/j.amjcard.2012.01.363","article-title":"Prognostic utility of metabolic exercise testing in minimally symptomatic patients with obstructive hypertrophic cardiomyopathy","volume":"109","author":"Sorajja","year":"2012","journal-title":"Am. J. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1016\/S0735-1097(00)00816-0","article-title":"Utility of metabolic exercise testing in distinguishing hypertrophic cardiomyopathy from physiologic left ventricular hypertrophy in athletes","volume":"36","author":"Sharma","year":"2000","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1016\/S0140-6736(20)31792-X","article-title":"Mavacamten for treatment of symptomatic obstructive hypertrophic cardiomyopathy (EXPLORER-HCM): A randomised, double-blind, placebo-controlled, phase 3 trial","volume":"396","author":"Olivotto","year":"2020","journal-title":"Lancet"},{"key":"ref_27","first-page":"741","article-title":"Mavacamten Treatment for Obstructive Hypertrophic Cardiomyopathy a Clinical Trial. Ann","volume":"170","author":"Heitner","year":"2019","journal-title":"Intern. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1002\/ejhf.1140","article-title":"A flattening oxygen consumption trajectory phenotypes disease severity and poor prognosis in patients with heart failure with reduced, mid-range, and preserved ejection fraction","volume":"20","author":"Popovic","year":"2018","journal-title":"Eur. J. Heart Fail."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1136\/heartjnl-2015-308453","article-title":"Cardiopulmonary exercise test and sudden cardiac death risk in hypertrophic cardiomyopathy","volume":"102","author":"Magri","year":"2016","journal-title":"Heart"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Velicki, L., Popovic, D., Okwose, N.C., Preveden, A., Tesic, M., Tafelmeier, M., Charman, S.J., Barlocco, F., Maier, L.S., and MacGowan, G.A. (, 2023). Sacubitril\/Valsartan for Treatment of Symptomatic Non-Obstructive Hypertrophic Cardiomyopathy: A Randomised, Controlled, Phase II Clinical Trial, on Behalf of SILICOFCM Study Investigators. Proceedings of the European Society of Cardiology Annual Congress, Amsterdam, The Netherlands. Unpublished work.","DOI":"10.1093\/eurheartj\/ehad655.1858"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2044","DOI":"10.1016\/S0735-1097(99)00094-7","article-title":"Prognostic value of systemic blood pressure response during exercise in a community-based patient population with hypertrophic cardiomyopathy","volume":"33","author":"Olivotto","year":"1999","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.ijcard.2018.04.019","article-title":"Clinical and prognostic impact of chronotropic incompetence in patients with hypertrophic cardiomyopathy","volume":"271","author":"Magri","year":"2018","journal-title":"Int. J. Cardiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2465","DOI":"10.1161\/CIRCULATIONAHA.112.110460","article-title":"The safety of cardiopulmonary exercise testing in a population with high-risk cardiovascular diseases","volume":"126","author":"Skalski","year":"2012","journal-title":"Circulation"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1161\/CIR.0b013e3181e52e69","article-title":"Clinician\u2019s Guide to Cardiopulmonary Exercise Testing in Adults","volume":"122","author":"Balady","year":"2010","journal-title":"Circulation"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1161\/CIRCULATIONAHA.109.878579","article-title":"Contemporary Insights and Strategies for Risk Stratification and Prevention of Sudden Death in Hypertrophic Cardiomyopathy","volume":"121","author":"Maron","year":"2010","journal-title":"Circulation"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.ijcard.2021.02.077","article-title":"Respiratory dyssynchrony is a predictor of prognosis in patients with hypertrophic non-obstructive cardiomyopathy","volume":"332","author":"Potratz","year":"2021","journal-title":"Int. J. Cardiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"258","DOI":"10.4330\/wjc.v8.i3.258","article-title":"Exercise oscillatory ventilation: Mechanisms and prognostic significance","volume":"8","author":"Dhakal","year":"2016","journal-title":"World J. Cardiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.ijcard.2021.03.049","article-title":"Cardiopulmonary exercise testing: An increasingly important step in managing hypertrophic cardiomyopathy","volume":"332","author":"Magri","year":"2021","journal-title":"Int. J. Cardiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2080","DOI":"10.1093\/eurheartj\/ehs064","article-title":"A contemporary European experience with surgical septal myectomy in hypertrophic cardiomyopathy","volume":"33","author":"Iacovoni","year":"2012","journal-title":"Eur. Heart J."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1177\/2047487320961898","article-title":"Risk stratification in cardiomyopathy","volume":"27","author":"Sinagra","year":"2020","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2265","DOI":"10.1016\/j.amjcard.2017.08.047","article-title":"Comparison of Valsalva maneuver, amyl nitrite, and exercise echocardiography to demonstrate latent left ventricular outflow obstruction in hypertrophic cardiomyopathy","volume":"120","author":"Ayoub","year":"2017","journal-title":"Am. J. Cardiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1093\/ehjci\/jew313","article-title":"Upright treadmill vs. semi-supine bicycle exercise echocardiography to provoke obstruction in symptomatic hypertrophic cardiomyopathy: A pilot study","volume":"19","author":"Reant","year":"2018","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1688","DOI":"10.1016\/j.amjcard.2020.03.004","article-title":"Phenotyping Left Ventricular Obstruction with Postprandial Re-Test Echocardiography in Hypertrophic Cardiomyopathy","volume":"125","author":"Scarfo","year":"2020","journal-title":"Am. J. Cardiol."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Argiro, A., Zampieri, M., Berteotti, M., Marchi, A., Tassetti, L., Zocchi, C., Iannone, L., Bacchi, B., Cappelli, F., and Stefano, P. (2021). Emerging Medical Treatment for Hypertrophic Cardiomyopathy. J. Clin. Med., 10.","DOI":"10.3390\/jcm10050951"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1093\/eurheartj\/ehy730","article-title":"Recommendations for participation in competitive and leisure time sport in athletes with cardiomyopathies, myocarditis, and pericarditis: Position statement of the Sport Cardiology Section of the European Association of Preventive Cardiology (EAPC)","volume":"40","author":"Pelliccia","year":"2019","journal-title":"Eur. Heart J."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1161\/01.CIR.83.3.778","article-title":"Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure","volume":"83","author":"Mancini","year":"1991","journal-title":"Circulation"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.1016\/j.jcmg.2017.07.016","article-title":"Role of Exercise Testing in Hypertrophic Cardiomyopathy","volume":"10","author":"Rowin","year":"2017","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1930","DOI":"10.1136\/heartjnl-2021-319861","article-title":"Exercise prescription in individuals with hypertrophic cardiomyopathy: What clinicians need to know","volume":"108","author":"Gati","year":"2022","journal-title":"Heart"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Bryde, R., Martinez, M.W., and Emery, M.S. (2023). Exercise recommendations for patients with hypertrophic cardiomyopathy. Prog. Cardiovasc. Dis.","DOI":"10.1016\/j.pcad.2023.05.004"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.amjcard.2017.09.026","article-title":"Effect of body mass index on exercise capacity in patients with hypertrophic cardiomyopathy","volume":"121","author":"Larsen","year":"2018","journal-title":"Am. J. Cardiol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1348","DOI":"10.1016\/j.ijcard.2014.07.268","article-title":"Exercise ventilatory power in heart failure patients: Functional phenotypes definition by combining cardiopulmonary exercise testing with stress echocardiography","volume":"176","author":"Labate","year":"2014","journal-title":"Int. J. Cardiol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1161\/CIRCHEARTFAILURE.113.001061","article-title":"Role of right ventricle and dynamic pulmonary hypertension on determining \u0394VO2\/\u0394Work Rate flattening: Insights from cardiopulmonary exercise test combined with exercise echocardiography","volume":"7","author":"Bandera","year":"2014","journal-title":"Circ. Heart Fail."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"372","DOI":"10.2459\/JCM.0b013e328355fb00","article-title":"Rest and latent obstruction in hypertrophic cardiomyopathy: Impact on exercise tolerance","volume":"14","author":"Re","year":"2013","journal-title":"J. Cardiovasc. Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1093\/eurheartj\/ehw180","article-title":"2016 focused update: Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations","volume":"39","author":"Guazzi","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"2593","DOI":"10.1007\/s10554-022-02620-0","article-title":"Pulmonary congestion during Exercise stress Echocardiography in Hypertrophic Cardiomyopathy","volume":"38","author":"Palinkas","year":"2022","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"2345","DOI":"10.1007\/s10554-022-02671-3","article-title":"Exercise-induced pulmonary hypertension in hypertrophic cardiomyopathy: A combined cardiopulmonary exercise test-echocardiographic study","volume":"38","author":"Re","year":"2022","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/j.jchf.2016.03.007","article-title":"Right Ventricular Contractile Reserve and Pulmonary Circulation Uncoupling During Exercise Challenge in Heart Failure: Pathophysiology and Clinical Phenotypes","volume":"4","author":"Guazzi","year":"2016","journal-title":"JACC Heart Fail."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Magr\u00ec, D., Mastromarino, V., Gallo, G., Zachara, E., Re, F., Agostoni, P., Giordano, D., Rubattu, S., Forte, M., and Cotugno, M. (2020). Risk Stratification in Hypertrophic Cardiomyopathy. Insights from Genetic Analysis and Cardiopulmonary Exercise Testing. J. Clin. Med., 9.","DOI":"10.3390\/jcm9061636"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.ccl.2018.08.010","article-title":"Role of Advanced Testing: Invasive Hemodynamics, Endomyocardial Biopsy, and Cardiopulmonary Exercise Testing","volume":"37","author":"Lanier","year":"2019","journal-title":"Cardiol. Clin."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1002\/ccd.26472","article-title":"Hemodynamic changes in systolic and diastolic function during isoproterenol challenge predicts symptomatic response to myectomy in hypertrophic cardiomyopathy with labile obstruction","volume":"88","author":"Prasad","year":"2016","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"e007000","DOI":"10.1161\/CIRCHEARTFAILURE.120.007000","article-title":"Invasive Hemodynamics of Hypertrophic Cardiomyopathy: Exercise Versus Isoproterenol","volume":"13","author":"Caravita","year":"2020","journal-title":"Circ. Heart Fail."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/7\/1296\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:11:36Z","timestamp":1760127096000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/7\/1296"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,13]]},"references-count":61,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,7]]}},"alternative-id":["medicina59071296"],"URL":"https:\/\/doi.org\/10.3390\/medicina59071296","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,13]]}}}