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Left ventricular outflow tract obstruction as a risk factor for sudden cardiac death in hypertrophic cardiomyopathy

Georgios K Efthimiadis1, Despina G Parcharidou, Georgios Giannakoulas

  • 1First Cardiology Department, Cardiomyopathies Laboratory, Aristotle University of Thessaloniki Medical School, AHEPA Hospital, Thessaloniki, Greece. efthymos@med.auth.gr

The American Journal of Cardiology
|August 25, 2009
PubMed

Insights

Left ventricular outflow tract obstruction (LVOTO) at rest does not appear to be an independent risk factor for sudden death (SD) in hypertrophic cardiomyopathy patients. Other factors like syncope and wall thickness are more significant indicators for SD risk.

Area of Science:

  • Cardiology
  • Clinical Medicine
  • Genetics

Background:

  • Hypertrophic cardiomyopathy (HCM) is a genetic heart muscle disease.
  • Sudden death (SD) is a major concern in HCM patients.
  • The role of left ventricular outflow tract obstruction (LVOTO) at rest in predicting SD in HCM remains controversial.

Purpose of the Study:

  • To evaluate the potential of resting left ventricular outflow tract obstruction (LVOTO) as a novel risk factor for sudden death (SD) in patients with hypertrophic cardiomyopathy (HCM).

Main Methods:

  • A cohort study involving 166 patients with HCM (112 men, mean age 51.8 years).
  • Patients were assessed for peak instantaneous LVOTO gradients at rest (≥30 mm Hg).
  • Follow-up median of 32.4 months for adverse cardiac events including SD, cardiac arrest, VT, or ICD discharge.

Main Results:

  • 13 patients experienced adverse events during follow-up.
  • Cumulative event-free survival was 92% in both LVOTO and non-LVOTO groups (p=NS).
  • Resting LVOTO showed a low positive predictive value (8%) but high negative predictive value (92%) for SD. Syncope and maximal wall thickness ≥3 cm were significant risk factors for SD.

Conclusions:

  • Resting left ventricular outflow tract obstruction (LVOTO) is not supported as an independent risk factor for sudden death (SD) in hypertrophic cardiomyopathy (HCM).
  • Syncope and marked left ventricular hypertrophy (wall thickness ≥3 cm) are more significant predictors of SD in HCM patients.
  • Further research may focus on combined risk stratification models for HCM.

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