Clinical Characteristics and Prognosis of End-stage Hypertrophic Cardiomyopathy

Abstract

Background:End-stage hypertrophic cardiomyopathy (HCM) is complicated by substantial adverse events. However, few studies have focused on electrocardiographic features and their prognostic values in HCM. This study aimed to evaluate the clinical manifestations and prognostic value of electrocardiography in patients with end-stage HCM.Methods:End-stage HCM patients were enrolled from a total of 1844 consecutive HCM patients from April 2002 to November 2013 at Fuwai Hospital. Clinical data, including medical history, electrocardiography, and echocardiography, were analyzed. Cox hazards regression analysis was used to assess the risk factors for cardiovascular mortality.Results:End-stage HCM was identified in 99 (5.4%) patients, averaged at 52 ± 16 years old at entry. Atrial fibrillation was observed in 53 patients and mural thrombus in 19 patients. During 3.9 ± 3.0 years of follow-up, embolic stroke, refractory heart failure, and death or transplantation were observed in 20, 39, and 51 patients, respectively. The incidence of annual mortality was 13.2%. Multivariate Cox hazards regression analysis identified New York Heart Association Class (NYHA) III/IV at entry (hazard ratio [HR]: 1.99; 95% confidence interval [CI]: 1.05–3.80; P = 0.036), left bundle branch block (LBBB) (HR: 2.80; 95% CI: 1.47–5.31; P = 0.002), and an abnormal Q wave (HR: 2.21; 95% CI: 1.16–4.23; P = 0.016) as independent predictors of cardiovascular death, in accordance with all-cause death and heart failure-related death.Conclusions:LBBB and an abnormal Q wave are risk factors of cardiovascular mortality in end-stage HCM and provide new evidence for early intervention. Susceptibility of end-stage HCM patients to mural thrombus and embolic events warrants further attention.

Survival and prognostic factors in hypertrophic cardiomyopathy: a meta-analysis

“…This was also confirmed in our study indicating that NYHA III/IV is an important prognostic factor for all-cause death (PAR = 7.79%) and cardiovascular death (PAR = 9.61%). In previous cohort studies, AF was reported to be a substantial risk factor for heart failure-related mortality and severe functional disability 12 , however, the significant relationship with AF disappeared in the multivariate model 16 , 27 . These results are in agreement with our study.…”

“…Advanced heart failure (NYHA III/IV) was reported as an independent predictor of cardiovascular mortality in end-stage HCM 16 , as patients with heart failure at diagnosis showed a trend toward more frequent adverse outcomes, probably because they had more advanced disease 11 . This was also confirmed in our study indicating that NYHA III/IV is an important prognostic factor for all-cause death (PAR = 7.79%) and cardiovascular death (PAR = 9.61%).…”

“…Similarly, there are major discrepancies concerning atrial fibrillation (AF) in HCM, in that some studies concluded that it was a prognostic factor 13 , 26 , 30 , whereas other studies indicated that it was not 9 , 16 , 20 . Conversely, in a recent review 18 , family history, aBPRE, and cardiac arrhythmia were recognized as important and indisputable prognostic factors for survival in idiopathic HCM.…”

Managing atrial fibrillation in the very elderly patient: challenges and solutions

“…Other less common causes are restrictive cardiomyopathies such as amyloidosis, constrictive pericarditis, cardiac tumors, and severe pulmonary hypertension. 10 Obstructive sleep apnea and obesity are independent risk factors for AF. 11 , 12 The electrical and structural remodeling determines the perpetuation of AF and the progression from paroxysmal to persistent and permanent forms.…”

Comparison of Clinical Effects between Percutaneous Transluminal Septal Myocardial Ablation and Modified Morrow Septal Myectomy on Patients with Hypertrophic Cardiomyopathy

“…Hypertrophic obstructive cardiomyopathy (HCM) is a disease characterized by hypertrophy of the interventricular septum, obstruction of left ventricular outflow tract (LVOT), and frequently, systolic anterior motion (SAM) of the mitral valve. [ 1 2 3 ] Although medical intervention can provide relief of symptoms, a considerable number of patients with hypertrophic obstructive cardiomyopathy remain symptomatic, and in these participants, invasive interventions such as percutaneous transluminal septal myocardial ablation (PTSMA) and modified Morrow septal myectomy (MMSM) are established treatment options. [ 4 5 ] Extended septal myectomy can significantly relieve obstruction of LVOT and improve main complaints.…”