Identification of heart failure with preserved ejection fraction helps risk stratification for hypertrophic cardiomyopathy

Abstract

Background Heart failure with preserved ejection fraction (HFpEF) is the dominant form of heart failure (HF). We here aimed to investigate the characteristics and prognosis of HFpEF in patients with hypertrophic cardiomyopathy (HCM). Methods This was a prospective cohort study and patients with HCM with available NT-proBNP results were enrolled. Patients were categorized into HFpEF [defined as LVEF ≥50%, with symptoms or signs of HF, and N-terminal pro-brain natriuretic peptide ≥800 pg/mL according to American Heart Association (AHA) criteria] and without heart failure (non-HF). The outcomes of interest were all-cause death, cardiovascular death, and sudden cardiac death (SCD). Results Of 1178 included patients with HCM, 513 (43.5%) were identified as having HFpEF according to AHA criteria. Compared with non-HF patients, patients with HFpEF had significantly larger maximal wall thickness (P < 0.001), higher maximal left ventricular outflow tract gradient (P < 0.001), higher proportion of atrial fibrillation (P < 0.001), higher incidence of all-cause death (log-rank test, P = 0.002), and cardiovascular death (log-rank test, P = 0.005). Multivariable Cox analysis showed that patients with HFpEF had a nearly two-fold higher risk of all-cause death (adjusted HR = 1.80, 95% CI 1.11–2.90; P = 0.017) and cardiovascular death (adjusted HR =1.82, 95% CI 1.05–3.18; P = 0.033) than non-HF patients. Conclusions Patients with HCM have a high prevalence of HFpEF and those with HFpEF present greater disease severity and higher mortality than non-HF patients, and thus may require an appropriate and more aggressive treatment for HF management. Identification of patients with HFpEF using AHA criteria can provide guidance on patient risk stratification for patients with HCM.

Focal ischemic myocardial fibrosis assessed by late gadolinium enhancement cardiovascular magnetic resonance in patients with hypertrophic cardiomyopathy

“…Moreover, patients with increased NT-proBNP levels were associated with an increased risk of cardiac death [ 29 , 30 ]. This suggests that I-LGE is a sign of advanced cardiomyopathy, which could explain the higher level of NT-proBNP than NI-LGE in HCM [ 31 ].…”

Left ventricular strain patterns and their relationships with cardiac biomarkers in hypertrophic cardiomyopathy patients with preserved left ventricular ejection fraction

“…According to the 2016 ESC guideline ( 30 ), the NT-proBNP cutoff value is 125 pg/mL, whereas the 2017 AHA criteria suggested using a threshold of 800 pg/mL ( 14 ). A study indicated that compared to the cut-off value of NT-proBNP of the ESC guideline, the AHA criteria are more conducive to risk stratification in HCM patients ( 31 ). Accordingly, in this study, we chose 800 pg/mL as the threshold criterion for the group.…”

Patient phenotype profiling in heart failure with preserved ejection fraction to guide therapeutic decision making. A scientific statement of the Heart Failure Association, the European Heart Rhythm Association of the European Society of Cardiology, and the European Society of Hypertension

“…180 Concomitant presence of both conditions is associated with a worse prognosis. 197 In patients with concomitant disease, general HFpEF treatment is advisable, in addition to treatment for hypertrophic cardiomyopathy. Briefly, in symptomatic patients, pharmaceutical treatment options include non-vasodilating beta-blockers, verapamil, disopyramide, and mavacamten.…”

“…Obstructive hypertrophic cardiomyopathy causes HFpEF in most patients, and non‐obstructive hypertrophic cardiomyopathy causes HFpEF in ∼10% of patients 180 . Concomitant presence of both conditions is associated with a worse prognosis 197 . In patients with concomitant disease, general HFpEF treatment is advisable, in addition to treatment for hypertrophic cardiomyopathy.…”