Beyond Peak VO2: VO2T12.5% Emerges as a Cardiospecific Marker of Performance and Therapeutic Response in Obstructive HCM

Highlights

  • VO2T12.5% (the time for VO2 to decline by 12.5% from peak) is established as a cardiospecific metric, correlating with exercise hemodynamics (PCWP/CO slope) rather than peripheral factors.
  • Prolonged VO2T12.5% is a robust independent predictor of heart failure hospitalization and mortality, with a hazard ratio of 1.54 per 15-second increase.
  • Treatment with the cardiac myosin inhibitor aficamten significantly accelerates VO2 recovery, with a mean improvement of 8 seconds compared to placebo.
  • Improvements in recovery speed correlate directly with physiological markers of reduced obstruction, including lower LVOT gradients and decreased cardiac biomarkers.

Introduction

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