RESUMEN
BACKGROUND: A transmitral E/septal Ea ratio > or =15 is a predictor of adverse outcome in cardiac disease, so it was hypothesized that a septal E/Ea >/=15 would predict the risk of adverse outcome, including sustained ventricular tachycardia (VT), cardiac arrest, implantable cardioverter defibrillator (ICD) discharge, or sudden death (SD) in patients with hypertrophic cardiomyopathy (HCM). METHODS AND RESULTS: The study group comprised 96 consecutive patients with HCM (median age 53 years) who completed all noninvasive tests for risk stratification. The endpoint of the study was defined as death, cardiac arrest, documented sustained VT, or ICD-discharge. The median follow-up was 20.6 months. All patients were alive at the end of follow-up, although 8 patients had reached the endpoint during the study period. The variables that were predictive of adverse clinical outcome were family history of premature SD (p=0.03), syncope (p<0.001), maximum wall thickness > or =3 cm (p=0.02), and septal E/Ea > or =15 (p<0.001). In a stepwise multivariable model the only independent prognostic indicator was a septal E/Ea > or =15 (relative risk 0.26, 95% confidence interval 0.2-0.58, p<0.001). The cumulative event-free survival rate was 78.9% in patients with septal E/Ea > or =15, and 100% in patients with septal E/Ea <15 (p=0.0003). CONCLUSIONS: Septal E/Ea > or =15 predicts patients with HCM who are at risk of sustained VT, cardiac arrest, ICD-discharge, or SD. (Circ J 2007; 71: 897 - 903).
Asunto(s)
Cardiomiopatía Hipertrófica/diagnóstico por imagen , Muerte Súbita Cardíaca , Ecocardiografía Doppler , Paro Cardíaco/diagnóstico por imagen , Taquicardia Ventricular/diagnóstico por imagen , Adulto , Cardiomiopatía Hipertrófica/complicaciones , Cardiomiopatía Hipertrófica/mortalidad , Cardiomiopatía Hipertrófica/fisiopatología , Muerte Súbita Cardíaca/etiología , Desfibriladores Implantables , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Paro Cardíaco/etiología , Paro Cardíaco/mortalidad , Paro Cardíaco/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Medición de Riesgo , Factores de Riesgo , Tasa de Supervivencia , Taquicardia Ventricular/etiología , Taquicardia Ventricular/mortalidad , Taquicardia Ventricular/fisiopatologíaRESUMEN
Hypertrophic cardiomyopathy (HC) may transition to a phase characterized by systolic impairment resembling dilated cardiomyopathy. This study retrospectively assessed the incidence of left ventricular (LV) systolic impairment at initial clinical evaluation in 248 consecutive patients with HC (mean age 53 +/- 16 years). HC with systolic impairment was diagnosed if the LV ejection fraction was <50%, calculated by echocardiography. Twenty patients (8%) had HC with LV systolic impairment at initial evaluation. Patients with systolic impairment had a greater incidence of family histories of sudden cardiac death (SCD) than patients with preserved systolic function (25% vs 5.3%, p = 0.006) and more severe functional limitations (New York Heart Association class >or=III, p <0.001). All-cause mortality and cardiovascular mortality did not differ between the 2 groups. The incidence of SCD was 1.7% in patients with normal LV ejection fractions, and no SCD was observed in patients with systolic impairment. The latter group had more frequent major cardiac events (SCD, ventricular fibrillation, aborted cardiac arrest, and first implantable cardioverter-defibrillator discharge; p = 0.03). During follow-up, 2 patients progressed to HC with systolic impairment (annual incidence 0.85%). In conclusion, systolic impairment is not exceptional in patients with HC at initial evaluation and is associated with functional deterioration and major cardiac events.