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Comparison of Outcomes in Patients With Nonobstructive, Labile-Obstructive, and Chronically Obstructive Hypertrophic Cardiomyopathy.
- Source :
-
American Journal of Cardiology . Sep2015, Vol. 116 Issue 6, p938-944. 7p. - Publication Year :
- 2015
-
Abstract
- Patients with nonobstructive hypertrophic cardiomyopathy (HC) are considered low risk, generally not requiring aggressive intervention. However, nonobstructive and labile-obstructive HC have been traditionally classified together, and it is unknown if these 2 subgroups have distinct risk profiles. We compared cardiovascular outcomes in 293 patients HC (96 nonobstructive, 114 labile-obstructive, and 83 obstructive) referred for exercise echocardiography and magnetic resonance imaging and followed for 3.3 ± 3.6 years. A subgroup (34 nonobstructive, 28 labile-obstructive, 21 obstructive) underwent positron emission tomography. The mean number of sudden cardiac death risk factors was similar among groups (nonobstructive: 1.4 vs labile-obstructive: 1.2 vs obstructive: 1.4 risk factors, p = 0.2). Prevalence of late gadolinium enhancement (LGE) was similar across groups but more non-obstructive patients had late gadolinium enhancement =20% of myocardial mass (23 [30%] vs 19 [18%] labile-obstructive and 8 [11%] obstructive, p = 0.01]. Fewer labile-obstructive patients had regional positron emission tomography perfusion abnormalities (12 [46%] vs nonobstructive 30 [81%] and obstructive 17 [85%], p = 0.003]. During follow-up, 60 events were recorded (36 ventricular tachycardia/ventricular fibrillation, including 30 defibrillator discharges, 12 heart failure worsening, and 2 deaths). Nonobstructive patients were at greater risk of VT/VF at follow-up, compared to labile obstructive (hazed ratio 0.18, 95% confidence interval 0.04 to 0.84, p = 0.03) and the risk persisted after adjusting for age, gender, syncope, family history of sudden cardiac death, abnormal blood pressure response, and septum =3 cm (p = 0.04). Appropriate defibrillator discharges were more frequent in nonobstructive (8 [18%]) compared to labile-obstructive (0 [0%], p = 0.02) patients. In conclusion, nonobstructive hemodynamics is associated with more pronounced fibrosis and ischemia than labile-obstructive and is an independent predictor of VT/VF in HC. [ABSTRACT FROM AUTHOR]
- Subjects :
- *HYPERTROPHIC cardiomyopathy
*VENTRICULAR fibrillation
*VENTRICULAR tachycardia
*CARDIAC arrest
*CARDIOPULMONARY system
*COMPARATIVE studies
*CONFIDENCE intervals
*ECHOCARDIOGRAPHY
*EXERCISE tests
*CARDIAC patients
*CARDIAC hypertrophy
*MAGNETIC resonance imaging
*PROBABILITY theory
*POSITRON emission tomography
*TREATMENT effectiveness
*DESCRIPTIVE statistics
*ODDS ratio
*DISEASE risk factors
*CARDIOVASCULAR diseases risk factors
Subjects
Details
- Language :
- English
- ISSN :
- 00029149
- Volume :
- 116
- Issue :
- 6
- Database :
- Academic Search Index
- Journal :
- American Journal of Cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 109218596
- Full Text :
- https://doi.org/10.1016/j.amjcard.2015.06.018