Role and Clinical Importance of Progressive Changes in Echocardiographic Parameters in Predicting Outcomes in Patients With Hypertrophic Cardiomyopathy

Abstract

BACKGROUND The prognostic utility of follow-up transthoracic echocardiography (FU-TTE) in patients with hypertrophic cardiomyopathy (HCM) is unclear, specifically in terms of whether changes in echocardiographic parameters in routine FU-TTE parameters are associated with cardiovascular outcomes. METHODS From 2010 to 2017, 162 patients with HCM were retrospectively enrolled in this study. Using echocardiography, HCM was diagnosed based on morphological criteria. Patients with other diseases that cause cardiac hypertrophy were excluded. TTE parameters at baseline and FU were analyzed. FU-TTE was designated as the last recorded value in patients who did not develop any cardiovascular event or the latest exam before event development. Clinical outcomes were acute heart failure, cardiac death, arrhythmia, ischemic stroke, and cardiogenic syncope. RESULTS Median interval between the baseline TTE and FU-TTE was 3.3 years. Median clinical FU duration was 4.7 years. Septal trans-mitral velocity/mitral annular tissue Doppler velocity (E/e’), tricuspid regurgitation velocity, left ventricular ejection fraction (LVEF), and left atrial volume index (LAVI) at baseline were recorded. LVEF, LAVI, and E/e’ values were associated with poor outcomes. However, no delta values predicted HCM-related cardiovascular outcomes. Logistic regression models incorporating changes in TTE parameters had no significant findings. Baseline LAVI was the best predictor of a poor prognosis. In survival analysis, an already enlarged or increased size LAVI was associated with poorer clinical outcomes. CONCLUSIONS Changes in echocardiographic parameters extracted from TTE did not assist in predicting clinical outcomes. Cross-sectionally evaluated TTE parameters were superior to changes in TTE parameters between baseline and FU at predicting cardiovascular events.

Effects of septal myectomy on left atrial and left ventricular function in obstructive hypertrophic cardiomyopathy

“…Diastolic dysfunction is a hallmark of HCM, and the clinical importance of LA enlargement and mechanical function, which are indicators of chronic LV diastolic dysfunction and thromboembolic risks, 19 , 20 , 21 , 22 is well known in patients with HCM. 9 , 10 , 11 , 12 , 23 While actively applying an implantable cardioverter defibrillator in patients at high risk of sudden cardiac death or performing septal myectomy in patients with symptomatic obstructive HCM, the residual risk in HCM patients is that of heart failure and stroke according to underlying LA and LV functions. 1 In addition, because interest in medical septal reduction therapy using cardiac myosin inhibitors has recently increased, 24 the effect of reducing LVOT obstruction on myocardial mechanics is expected to become an important issue.…”

“…Impairment of LV global longitudinal strain (GLS) in HCM is a significant prognostic factor of future clinical events such as sudden cardiac death, heart failure, and ventricular arrhythmia 5–8 . Left atrium (LA) size and function affected by progression of LV diastolic dysfunction also are prognostic factors in patients with HCM 9–12 . Therefore, studying LA and LV mechanical functional changes after septal myectomy would be clinically important to predict prognosis in patients with obstructive HCM.…”

“… 5 , 6 , 7 , 8 Left atrium (LA) size and function affected by progression of LV diastolic dysfunction also are prognostic factors in patients with HCM. 9 , 10 , 11 , 12 Therefore, studying LA and LV mechanical functional changes after septal myectomy would be clinically important to predict prognosis in patients with obstructive HCM.…”

Longitudinal Changes of Left Atrial Volume Index as a Prognosticator in Hypertrophic Cardiomyopathy

“… 3) Other studies have suggested different parameters, such as changes in left atrial volume index (LAVI), to be clinically significant. 6) However, even with the abundance of longitudinal echocardiographic data for HCM patients, there is no consensus on the clinical meaning of changes in echocardiographic predictors (e.g., LVEF, left ventricular outflow tract obstruction, LAVI, E/e′, tricuspid regurgitation velocity, and maximum wall thickness) over a certain period. Thus, the authors of this study attempted to re-evaluate certain echocardiographic predictors and retrospectively scrutinize the changes in patient echocardiograms throughout the course of the disease to determine which echocardiographic parameters are clinically useful as predictors of poor cardiovascular outcomes.…”