https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Heidelberg Klinik für Innere Med. III, Kardiologie, Angiologie u. Pneumologie Heidelberg, Deutschland; 2Universitätsklinikum Heidelberg Innere Med. VII, Sportmedizin Heidelberg, Deutschland
Dilated cardiomyopathy (DCM) is a myocardial disease characterized by diverse etiologies, including idiopathic, familial/genetic, inflammatory and toxic forms. The heterogeneity in clinical presentation poses challenges in management, particularly from a sports medicine perspective. In this cross-sectional observational study conducted at the University Hospital Heidelberg from 2019 to 2023, we investigated the clinical presentation of DCM patients through comprehensive clinical and sports medicine assessments, including electrocardiography (ECG), the 6-Minute Walk Test, echocardiography, coronary angiography, cardiac MRI and laboratory tests. Sports medicine evaluations comprised spiroergometry with lactate measurements, muscle sonography and hand-grip tests.
A total of 93 DCM patients who also visited the sports medicine department were recruited. The majority were male (65%) and oligosymptomatic, with 43% classified as New York Heart Association (NYHA) class I and 49% as NYHA class II. Etiologies were classified as idiopathic (58%), inflammatory (23%), and familial/genetic (19%). The mean left ventricular ejection fraction (LV-EF) was 34.5 ± 8.8% and the median left ventricular end-diastolic diameter (LVEDD) was 58 mm. Cardiac biomarkers were slightly elevated, with a median NT-proBNP of 305 ng/L (IQR 206-398) and a median high-sensitivity troponin T of 9 pg/mL (IQR 8-10). Most patients exhibited cardiac limitations at maximum functional exercise capacity. The mean maximum oxygen uptake (VO₂ max) was 1,919 ± 0.652 mL/min, with the majority reaching a respiratory exchange ratio (RER) cutoff of 1.04.
No statistically significant differences were found among the different DCM etiologies regarding NYHA classification, LV-EF, cardiac biomarkers, or the 6-Minute Walk Test. However, a significant difference in VO₂ max was observed between subgroups (familial/genetic DCM: 2.332 ± 0.827 mL/min; inflammatory DCM: 2.079 ± 0.712 mL/min; idiopathic DCM: 1.745 ± 0.503 mL/min; p = 0.023).
This study provides a comprehensive clinical phenotyping of DCM patients from a sports medicine perspective. While typical clinical parameters did not differ significantly among DCM subgroups, familial/genetic DCM patients demonstrated a significantly higher VO₂ max during spiroergometry, suggesting potential implications for tailored exercise recommendations.