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Prognostic significance of radionuclide-assessed diastolic function in hypertrophic cardiomyopathy
T Chikamori1, S Dickie, J D Poloniecki
1Hammersmith Hospital, London, United Kingdom.
Insights
Diastolic function in hypertrophic cardiomyopathy (HC) is not a strong predictor of disease-related death. Other factors like age and syncope are more significant indicators for adverse outcomes in HC patients.
Area of Science:
- Cardiology
- Nuclear Medicine
- Medical Imaging
Background:
- Hypertrophic cardiomyopathy (HC) is a complex genetic heart disease.
- Prognostic markers for HC are crucial for patient management.
- Diastolic dysfunction is a common feature of HC, but its prognostic value is debated.
Purpose of the Study:
- To assess the prognostic significance of diastolic function in patients with hypertrophic cardiomyopathy.
- To identify key predictors of disease-related death in HC.
Main Methods:
- Technetium-99m gated equilibrium radionuclide angiography was performed in 161 HC patients.
- Five diastolic indexes were calculated from the radionuclide angiography.
- Patients were followed for disease-related deaths over 3.0 +/- 1.9 years.
Main Results:
- Univariate analysis showed younger age, syncope, dyspnea, reduced peak filling rate, increased relative filling volume, and decreased atrial contribution were associated with disease-related death.
- Stepwise discriminant analysis identified young age, syncope, reduced peak ejection rate, family history, reduced peak filling rate, and left ventricular hypertrophy as significant predictors of death.
- Excluding diastolic indexes from the analysis did not significantly alter the predictability of disease-related death.
Conclusions:
- Diastolic function indexes, while associated with adverse outcomes, are not the most significant predictors of disease-related death in hypertrophic cardiomyopathy.
- Clinical factors such as age at diagnosis and presence of syncope are more powerful prognostic indicators in HC.
- Further research may be needed to refine prognostic models for hypertrophic cardiomyopathy.
Abstract:
To evaluate the prognostic significance of diastolic function in hypertrophic cardiomyopathy (HC), technetium-99m gated equilibrium radionuclide angiography, acquired in list mode, was performed in 161 patients. Five diastolic indexes were calculated. During 3.0 +/- 1.9 years, 13 patients had disease-related deaths. With univariate analysis, these patients were younger (29 +/- 20 vs 42 +/- 16 years; p less than 0.05), had a higher incidence of syncope (p less than 0.025), dyspnea (p less than 0.001), reduced peak filling rate (2.9 +/- 0.9 vs 3.4 +/- 1.0 end-diastolic volume/s; p = 0.09) with increased relative filling volume during the rapid filling period (80 +/- 7 vs 75 +/- 12%; p = 0.06) and decreased atrial contribution (17 +/- 7 vs 22 +/- 11%; p = 0.07). Stepwise discriminant analysis revealed that young age at diagnosis, syncope at diagnosis, reduced peak ejection rate, positive family history, reduced peak filling rate, increased relative filling volume by peak filling rate and concentric left ventricular hypertrophy were the most statistically significant (p = 0.0001) predictors of disease-related death (sensitivity 92%, specificity 76%, accuracy 77%, positive predictive value 25%). Discriminant analysis excluding the diastolic indexes, however, showed similar predictability (sensitivity 92%, specificity 76%, accuracy 78%, positive predictive value 26%). To obtain more homogeneous groups for analysis, patients were classified as survivors (116) or electrically unstable (40), including sudden death, out-of-hospital ventricular fibrillation and nonsustained ventricular tachycardia during 48-hour ambulatory electrocardiography, and heart failure death or cardiac transplant (5).(ABSTRACT TRUNCATED AT 250 WORDS)