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Echocardiographic Predictors of All-Cause Mortality in Patients with Hypertrophic Cardiomyopathy following Pacemaker
Nixiao Zhang1, Wei Hua1, Xiaoping Li2
1Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Insights
In hypertrophic cardiomyopathy (HCM) patients receiving pacemakers, a left atrial diameter (LAD) of 44mm or greater is an independent predictor of all-cause mortality. This finding aids in risk stratification for HCM patients after pacemaker implantation.
Area of Science:
- Cardiology
- Medical Imaging
- Clinical Research
Background:
- Hypertrophic cardiomyopathy (HCM) is a complex cardiac condition requiring careful management.
- Pacemaker implantation is a treatment for symptomatic bradycardia in HCM patients.
- Identifying predictors of long-term mortality in HCM is crucial for patient care.
Purpose of the Study:
- To investigate the association between echocardiographic parameters, specifically left atrial diameter (LAD) and left ventricular end-diastolic diameter (LVEDD), and long-term all-cause mortality risk.
- To assess these parameters in adults with HCM following pacemaker implantation.
Main Methods:
- Retrospective analysis of 94 adult HCM patients who underwent pacemaker implantation (2002-2013).
- Evaluation of clinical characteristics, LAD, and LVEDD in 74 and 76 patients, respectively.
- Utilized ROC curves to determine predictive thresholds (LAD ≥44mm, LVEDD ≥43mm) and Kaplan-Meier survival and Cox regression analyses.
Main Results:
- Both LAD ≥44mm and LVEDD ≥43mm were significantly associated with all-cause mortality (log-rank test P < 0.05).
- Cox regression identified LAD ≥44mm as an independent predictor of all-cause mortality (HR 3.580, P=0.041).
- LVEDD ≥43mm was not a significant independent predictor, while LVOTO was associated with mortality (HR 0.166, P=0.022).
Conclusions:
- In hypertrophic cardiomyopathy patients who have received a pacemaker, a left atrial diameter (LAD) of 44mm or greater is an independent predictor of all-cause mortality.
- These echocardiographic findings can aid in risk stratification and management strategies for HCM patients post-pacemaker implantation.
Objectives:
To examine the association between the echocardiographic parameters measured as left atrial diameter (LAD) and left ventricular end-diastolic diameter (LVEDD) and long-term risk of all-cause mortality in adults with hypertrophic cardiomyopathy (HCM) following pacemaker implantation.
Methods:
A total of 94 adult patients with HCM who underwent pacemaker implantation from November 2002 to June 2013 in our Arrhythmia Center for symptomatic bradycardia and did not receive an implantable cardiac defibrillator (ICD) or cardiac resynchronization therapy (CRT) during follow-up were retrospectively extracted.
Results:
After careful examination of the medical records, we retrospectively evaluated the clinical characteristics of 74 patients with LAD records (58.1 ± 14.9 years) and 76 patients with LVEDD records (57.6 ± 15.2 years). Based on the receiver-operating characteristic (ROC) curve, the values of LAD = 44 mm and LVEDD = 43 mm were identified to predict the all-cause mortality. In the Kaplan–Meier survival, LAD ≥44 mm and LVEDD ≥43 mm were both significantly associated with all-cause mortality (log-rank test P < 0.05). Cox regression analysis indicated that LAD ≥44 mm (HR 3.580; 95% CI = 1.055–12.148; P=0.041) was an independent predictor of all-cause mortality, while LVEDD ≥43 mm was not significantly associated with all-cause mortality. LVOTO was also significantly associated with all-cause mortality (HR = 0.166; 95% CI = 0.036–0.771; P=0.022).
Conclusions:
In HCM patients with pacemaker implantation, LAD ≥44 mm was an independent predictor of all-cause mortality.
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