Incremental prognostic value of restrictive filling pattern in hypertrophic cardiomyopathy: a Doppler
Bruno Pinamonti1, Andrea Di Lenarda, Gaetano Nucifora
1Cardiovascular Department, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Trieste, Trieste, Italy. bpinamonti@hotmail.com
Insights
Restrictive filling pattern (RFP) is uncommon in hypertrophic cardiomyopathy (HCM) but indicates a higher risk of adverse cardiac events. Echocardiography-Doppler assessment of filling patterns improves prognostic accuracy in HCM patients.
Area of Science:
- Cardiology
- Echocardiography
- Cardiovascular Imaging
Background:
- Hypertrophic cardiomyopathy (HCM) is a primary cardiac disease.
- Assessing prognostic indicators in HCM is crucial for patient management.
- The prognostic value of restrictive filling pattern (RFP) in HCM requires further investigation.
Purpose of the Study:
- To determine the frequency of restrictive filling pattern (RFP) in hypertrophic cardiomyopathy (HCM) patients.
- To evaluate the incremental prognostic value of RFP in predicting adverse outcomes in HCM.
Main Methods:
- Eighty-seven HCM patients underwent physical and Doppler echocardiographic evaluation.
- Patients were followed for a mean of 96 months.
- Multivariate proportional hazard models and ROC curve analysis were used to identify predictors of cardiac death or heart transplantation.
Main Results:
- Restrictive filling pattern (RFP) was identified in 16% of HCM patients.
- Patients with RFP exhibited higher NYHA class, more heart failure signs, and lower ejection fraction.
- RFP was a significant independent predictor of cardiac death or heart transplantation (HR=2.94, P=0.01).
- Inclusion of RFP and indexed left atrial diameter improved the predictive model's AUC from 0.76 to 0.84 (P=0.01).
Conclusions:
- Restrictive filling pattern (RFP), though not frequent, is present in a notable proportion of HCM patients.
- Echocardiography-Doppler assessment of filling patterns provides significant additional prognostic information beyond clinical stratification in HCM.
Aim:
To study frequency and incremental prognostic value of restrictive filling pattern (RFP) in hypertrophic cardiomyopathy (HCM).
Methods And Results:
Eighty-seven consecutive HCM patients (64% men, mean age 45 +/- 19 years) underwent physical and Doppler echocardiographic evaluation at our centre from March 1993 to February 2001. Mean length of follow-up was 96 +/- 54 months. RFP was found in 14 patients (16%) at index evaluation. Patients with RFP had higher NYHA class, more frequent signs of heart failure and lower left ventricular ejection fraction (P = 0.018, P = 0.002 and P = 0.001, respectively). During follow-up, cardiac death plus heart transplantation was significantly higher in HCM patients with RFP than in those without RFP (P = 0.0001). NYHA class (HR = 5.95, 95% CI: 1.34-26.38, P = 0.019), indexed left atrial diameter (HR = 1.68, 95% CI: 1.01-2.82, P = 0.047) and RFP (HR = 2.94, 95% CI: 1.25-6.88, P = 0.01) were selected as predictors of cardiac death or heart transplantation in a multivariate proportional hazard model. The AUC of ROC curve from multivariate regression models for predicting adverse outcome significantly improved from 0.76 considering only NYHA class to 0.84 after inclusion of RFP and indexed left atrial diameter (P = 0.01).
Conclusions:
RFP is rare, but not exceptional, in HCM. Echo-Doppler evaluation of filling pattern confers additional prognostic power to clinical stratification.
Related Concept Videos
01:29Cardiomyopathy IV: Restrictive Cardiomyopathy
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:29Heart Failure II: Pathophysiology