Prognostic role of stress echocardiography in hypertrophic cardiomyopathy: The International Stress Echo Registry

Ciampi, Quirino; Olivotto, Iacopo; Gardini, Chiara; Mori, Fabio; Peteiro, Jesús; Monserrat, Lorenzo; Fernández, Xusto; Cortigiani, Lauro; Rigo, Fausto; Lopes, Luís Rocha; Cruz, Inês; Cotrim, Carlos; Losi, Maria Angela; Betocchi, Sandro; Beleslin, Branko; Tešić, Milorad; Dikić, Ana Djordjević; Lazzeroni, E; Lazzeroni, Davide; Sicari, Rosa

doi:10.1016/j.ijcard.2016.06.044

Cited by 43 publications

(62 citation statements)

References 42 publications

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“…There is still a need for replication of our findings with large‐scale studies with longer follow‐up. We used a composite clinical end point, like other seminal articles on HCM . Several articles document the low rates of death and adverse events in HCM .…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

“…We used a composite clinical end point, like other seminal articles on HCM. 37,38 Several articles document the low rates of death and adverse events in HCM. 22,39 Moreover, using death as the only end point ignores the serious nonfatal complications in HCM that affect quality of life.…”

Section: Limitations Of the Studymentioning

confidence: 99%

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

Pozios

Haileselassie

et al. 2018

JAHA

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“…Current guidelines recommend SE solely for evaluation of left ventricular outflow tract obstruction [33]. However, large-scale registry data show that SE positivity for ischemic criteria (such as new wall motion abnormalities and coronary flow velocity reserve) rather than inducible gradients predict adverse outcome in hypertrophic cardiomyopathy [34]. Thus, important prognostic as well as functional information may be derived from SE, although their clinical impact remains limited due lack of standardized data collection and uniform protocols.…”

Section: Methodsmentioning

confidence: 99%

“…A pilot study showed an incidence of events around 8% per year [34]. If we assume a positivity rate to SE (by composite criteria) of 40%, with doubling of likelihood of events in presence of SE positivity (by any criteria), with a power of 80%, an alpha error of 5%, and an attrition rate of 10%, a sample size of about 250 patients is required.…”

Section: Methodsmentioning

confidence: 99%

Stress echo 2020: the international stress echo study in ischemic and non-ischemic heart disease

Picaño

Ciampi

Citro

et al. 2017

Cardiovasc Ultrasound

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BackgroundStress echocardiography (SE) has an established role in evidence-based guidelines, but recently its breadth and variety of applications have extended well beyond coronary artery disease (CAD). We lack a prospective research study of SE applications, in and beyond CAD, also considering a variety of signs in addition to regional wall motion abnormalities.MethodsIn a prospective, multicenter, international, observational study design, > 100 certified high-volume SE labs (initially from Italy, Brazil, Hungary, and Serbia) will be networked with an organized system of clinical, laboratory and imaging data collection at the time of physical or pharmacological SE, with structured follow-up information. The study is endorsed by the Italian Society of Cardiovascular Echography and organized in 10 subprojects focusing on: contractile reserve for prediction of cardiac resynchronization or medical therapy response; stress B-lines in heart failure; hypertrophic cardiomyopathy; heart failure with preserved ejection fraction; mitral regurgitation after either transcatheter or surgical aortic valve replacement; outdoor SE in extreme physiology; right ventricular contractile reserve in repaired Tetralogy of Fallot; suspected or initial pulmonary arterial hypertension; coronary flow velocity, left ventricular elastance reserve and B-lines in known or suspected CAD; identification of subclinical familial disease in genotype-positive, phenotype- negative healthy relatives of inherited disease (such as hypertrophic cardiomyopathy).ResultsWe expect to recruit about 10,000 patients over a 5-year period (2016-2020), with sample sizes ranging from 5,000 for coronary flow velocity/ left ventricular elastance/ B-lines in CAD to around 250 for hypertrophic cardiomyopathy or repaired Tetralogy of Fallot. This data-base will allow to investigate technical questions such as feasibility and reproducibility of various SE parameters and to assess their prognostic value in different clinical scenarios.ConclusionsThe study will create the cultural, informatic and scientific infrastructure connecting high-volume, accredited SE labs, sharing common criteria of indication, execution, reporting and image storage of SE to obtain original safety, feasibility, and outcome data in evidence-poor diagnostic fields, also outside the established core application of SE in CAD based on regional wall motion abnormalities. The study will standardize procedures, validate emerging signs, and integrate the new information with established knowledge, helping to build a next-generation SE lab without inner walls.

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“…In one study, patients that had both exercise-induced WMAs and delayed hyperenhacement signal on a magnetic resonance study had the worse prognosis [46]. Also, in a recent multicentric study, it was observed that the best markers of poor outcome were those based on ischemia, as assessed by either WMAs assessment or coronary flow reserve, instead of haemodynamic markers such as exercise-induced obstruction or change in blood pressure [47].…”

Section: Ischemia In Non-cadmentioning

confidence: 99%

Novelties on Stress Echocardiography for the Assessment of Ischemia

Peteiro¹

2017

Int Arch Intern Med

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Prognostic role of stress echocardiography in hypertrophic cardiomyopathy: The International Stress Echo Registry

Cited by 43 publications

References 42 publications

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

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

Stress echo 2020: the international stress echo study in ischemic and non-ischemic heart disease

Novelties on Stress Echocardiography for the Assessment of Ischemia

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