Latent Obstruction and Left Atrial Size Are Predictors of Clinical Deterioration Leading to Septal Reduction in Hypertrophic Cardiomyopathy

Finocchiaro, Gherardo; Haddad, François; Pavlović, Aleksandra; Sinagra, Gianfranco; Schnittger, Ingela; Knowles, Joshua; Pérez, Marco; Magavern, Emma; Myers, Jonathan A.; Ashley, Euan A.

doi:10.1016/j.cardfail.2014.01.014

Cited by 15 publications

(13 citation statements)

References 27 publications

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“…If left atrial size is a mirror of LV filling pressures, these results suggest a main role of septal reduction procedure in their relief and confirm the role of exercise echocardiography in the assessment of latent obstruction, as previously demonstrated. 25 In contrast to previous studies, we did not observe a significant improvement in diastolic function, in particular considering Tissue Doppler parameters as E' and E/E'. Again this may be a result of the different demographics of the cohort considered, where possibly diastolic dysfunction becomes fixed and not influenced by factors such as LV obstruction when the disease history is longer.…”

Section: Discussioncontrasting

confidence: 99%

“…It is likely that obstruction relief decompresses the atria and this is followed by a true reverse remodeling observed 1 year after. If left atrial size is a mirror of LV filling pressures, these results suggest a main role of septal reduction procedure in their relief and confirm the role of exercise echocardiography in the assessment of latent obstruction, as previously demonstrated . In contrast to previous studies, we did not observe a significant improvement in diastolic function, in particular considering Tissue Doppler parameters as E’ and E/E’.…”

Section: Discussionsupporting

confidence: 88%

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Impact of Septal Reduction on Left Atrial Size and Diastole in Hypertrophic Cardiomyopathy

et al. 2016

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 88%

Impact of Septal Reduction on Left Atrial Size and Diastole in Hypertrophic Cardiomyopathy

et al. 2016

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“…20,21 As for HCM, previous studies have reported that an enlarged left atrium is a marker of disease severity and predicts adverse cardiovascular events. 15,22,23 In addition, left atrial dilatation is a sensitive, specific marker for the occurrence of AF. 24,25 Therefore, patients with HCM with an enlarged LAD are thought to be predisposed to the development of AF-whether an asymptomatic paroxysmal episode or a first paroxysmal episode of AF-which in turn may cause stroke and systemic embolic events in patients without previously documented AF.…”

Section: April 2016mentioning

confidence: 99%

Stroke and Embolic Events in Hypertrophic Cardiomyopathy

Haruki

Minami

Hagiwara

2016

Stroke

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Background and Purpose-Stroke and systemic embolic events are known to occur as complications of hypertrophic cardiomyopathy (HCM), and these complications are more common in patients with accompanying atrial fibrillation (AF). The diagnosis of AF is sometimes difficult, however, and it is possible that subclinical asymptomatic paroxysmal episodes or a first episode of AF in patients without previously documented AF may lead to embolic events. We investigated the prevalence of embolic events in patients with HCM and evaluated risk factors for these events in patients without documented AF. Methods-This study enrolled 593 patients with clinically diagnosed HCM (age at diagnosis, 51.0±15.6 years) from 1980 to 2010. Results-During a mean follow-up of 10.7±7.5 years, 68 (11.5%) experienced stroke and embolic events. AF had been documented before the event in 29 (42.6%) of them. AF was documented for the first time at the time of the event in 5 (7.4%) and after the event in 10 (14.7%). Among the 431 patients without previously documented AF (39 with events and 392 without events), older age at diagnosis and left atrial dimension ≥48 mm were identified as the independent determinants of the embolic event after adjusting for sex and classic prognostic markers related to HCM. Conclusions-The incidence of stroke and embolic events was about 1.0% per year in the HCM cohort. AF had not been previously documented before the event in more than half of patients with events. Older age and enlarged left atrial dimension are possible risk factors for embolic events in patients with HCM without documented AF.

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“…Approximately two thirds of patients with HCM demonstrate a dynamic left ventricular outflow tract (LVOT) gradient at rest or with provocation. This obstruction is thought to be the primary driver of symptoms . A resting LVOT gradient ≥30 mm Hg is a strong independent predictor for progression of HF and death .…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcomes in Patients With Nonobstructive, Labile, and Obstructive Hypertrophic Cardiomyopathy

Pozios

Haileselassie

et al. 2018

JAHA

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BackgroundHypertrophic cardiomyopathy (HCM) is a common inherited cardiac disease characterized by varying degrees of left ventricular outflow tract obstruction. In a large cohort, we compare the outcomes among 3 different hemodynamic groups.Methods and ResultsWe prospectively enrolled patients fulfilling standard diagnostic criteria for HCM from January 2005 to June 2015. Detailed phenotypic characterization, including peak left ventricular outflow tract pressure gradients at rest and after provocation, was measured by echocardiography. The primary outcome was a composite cardiovascular end point, which included new‐onset atrial fibrillation, new sustained ventricular tachycardia/ventricular fibrillation, new or worsening heart failure, and death. The mean follow‐up was 3.4±2.8 years. Among the 705 patients with HCM (mean age, 52±15 years; 62% men), 230 with obstructive HCM were older and had a higher body mass index and New York Heart Association class. The 214 patients with nonobstructive HCM were more likely to have a history of sustained ventricular tachycardia/ventricular fibrillation and implantable cardioverter defibrillator implantation. During follow‐up, 121 patients experienced a composite cardiovascular end point. Atrial fibrillation occurred most frequently in the obstructive group. Patients with nonobstructive HCM had more frequent sustained ventricular tachycardia/ventricular fibrillation events. In multivariate analysis, obstructive (hazard ratio, 2.80; 95% confidence interval, 1.64–4.80) and nonobstructive (hazard ratio, 1.94; 95% confidence interval, 1.09–3.45) HCM were associated with more adverse events compared with labile HCM.ConclusionsNonobstructive HCM carries notable morbidity, including a higher arrhythmic risk than the other HCM groups. Patients with labile HCM have a relatively benign clinical course. Our data suggest detailed sudden cardiac death risk stratification in nonobstructive HCM and monitoring with less aggressive management in labile HCM.

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Latent Obstruction and Left Atrial Size Are Predictors of Clinical Deterioration Leading to Septal Reduction in Hypertrophic Cardiomyopathy

Cited by 15 publications

References 27 publications

Impact of Septal Reduction on Left Atrial Size and Diastole in Hypertrophic Cardiomyopathy

Impact of Septal Reduction on Left Atrial Size and Diastole in Hypertrophic Cardiomyopathy

Stroke and Embolic Events in Hypertrophic Cardiomyopathy

Clinical Outcomes in Patients With Nonobstructive, Labile, and Obstructive Hypertrophic Cardiomyopathy

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