1. Value of Genetic Testing for the Prediction of Long-Term Outcome in Patients With Hypertrophic Cardiomyopathy
- Author
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Michelle Michels, Pieter A. Vriesendorp, Marjon van Slegtenhorst, Hannah G. van Velzen, Arend F.L. Schinkel, Rogier A. Oldenburg, Jolanda van der Velden, Cardiology, Clinical Genetics, Physiology, and ICaR - Heartfailure and pulmonary arterial hypertension
- Subjects
Adult ,0301 basic medicine ,medicine.medical_specialty ,Myosin Light Chains ,Genotype ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Gene mutation ,Sudden cardiac death ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Cause of Death ,Internal medicine ,medicine ,Humans ,Genetic Testing ,Prospective Studies ,Mortality ,Aged ,Proportional Hazards Models ,Heart Failure ,Myosin Heavy Chains ,Proportional hazards model ,business.industry ,Hypertrophic cardiomyopathy ,High-Throughput Nucleotide Sequencing ,Sequence Analysis, DNA ,Cardiomyopathy, Hypertrophic ,Middle Aged ,Prognosis ,medicine.disease ,Death, Sudden, Cardiac ,030104 developmental biology ,Cardiovascular Diseases ,Heart failure ,Multivariate Analysis ,Cardiology ,Population study ,Carrier Proteins ,Cardiology and Cardiovascular Medicine ,business ,Cardiac Myosins ,Cohort study - Abstract
Pathogenic gene mutations are found in about 50% of patients with hypertrophic cardiomyopathy (HC). Previous studies have shown an association between sarcomere mutations and medium-term outcome. The association with long-term outcome has not been described. The aim of this cohort study was to assess the long-term outcomes of patients with genotype positive (G+) and genotype negative (G-) HC. The study population consisted of 626 patients with HC (512 probands and 114 relatives) who underwent phenotyping and genetic testing from 1985 to 2014. End points were all-cause mortality, cardiovascular (CV) mortality, heart failure (HF)-related mortality, and sudden cardiac death/aborted sudden cardiac death (SCD/aborted SCD). Kaplan-Meier and multivariate Cox regression analyses were performed. A pathogenic mutation was detected in 327 patients (52%). G+ probands were younger than G- probands (46 ± 15 vs 55 ± 15 years, p0.001), had more non sustained ventricular tachycardia (34% vs 13%; p0.001), more often a history of syncope (14% vs 7%; p = 0.016), and more extreme hypertrophy (maximal wall thickness ≥30 mm, 7% vs 1%; p0.001). G- probands were more symptomatic (New York Heart Association ≥II, 73% vs 53%, p0.001) and had higher left ventricular outflow tract gradients (42 ± 39 vs 29 ± 33 mm Hg, p = 0.001). During 12 ± 9 years of follow-up, G+ status was an independent risk factor for all-cause mortality (hazard ratio [HR] 1.90, 95% CI 1.14 to 3.15; p = 0.014), CV mortality (HR 2.82, 95% CI 1.49 to 5.36; p = 0.002), HF-related mortality (HR 6.33, 95% CI 1.79 to 22.41; p = 0.004), and SCD/aborted SCD (HR 2.88, 95% CI 1.23 to 6.71; p = 0.015). In conclusion, during long-term follow-up, patients with G+ HC are at increased risk of all-cause death, CV death, HF-related death, and SCD/aborted SCD.
- Published
- 2016