Phenotyping of Exercise Response in FORMs of Arrhythmogenic CardioMyopathy: PERFORM-ACM
Year: 2026
Type: article
Abstract: Patients with arrhythmogenic cardiomyopathy (ACM) are advised to perform no more than moderate-intensity exercise, but whether such exercise acutely alters hemodynamic, electrophysiological, or cardiac biomarker profiles is unknown. We investigated whether moderate-intensity isometric, resistance, or aerobic exercise induces exercise pulmonary hypertension (exPH, mean pulmonary artery pressure to cardiac output slope >3 mmHg/L/min), troponin T elevation, or changes in late potentials (LP) in definitive or probable ACM. Twenty patients (13 definitive, 7 probable ACM; age 42.2 ± 10.7 years) underwent exercise right heart catheterization during isometric handgrip (HG) and bicep curl (BC) (1 minute each at 70% of maximal voluntary contraction), followed by 2 × 20 minutes of supine cycling (CYC) at the first ventilatory threshold. Central hemodynamics and cardiac biomarkers were measured during each condition, and high-density right ventricular electroanatomical mapping was performed before and after exercise. exPH did not occur in either group (all <3 mmHg/L/min), whereas troponin T rose progressively without group differences (p=0.880). LP within the "arrhythmogenic triangle" decreased in probable (mean change -1.95 ± 1.59%) but increased in definitive ACM (mean change 2.72 ± 2.16%, p<0.001). In conclusion, moderate-intensity HG, BC, and CYC exercise were not associated with exPH in probable or definitive ACM. Despite similar hemodynamic and biomarker responses, post-exercise LP diverged between groups, decreasing in probable but increasing in definitive ACM. This observation warrants validation in larger cohorts with better control for baseline substrate and longitudinal clinical outcomes.
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7225736430
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