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[Cardiac function and prognosis in hypertrophic cardiomyopathy]
1First Department of Internal Medicine, Kobe University School of Medicine.
Insights
Echocardiography helps assess hypertrophic cardiomyopathy (HCM) progression. Increased left ventricular dimension and decreased filling rates in HCM patients indicate poorer prognoses, guiding clinical observation.
Area of Science:
- Cardiology
- Echocardiography
- Cardiovascular Disease
Context:
- Hypertrophic cardiomyopathy (HCM) is a complex cardiac condition requiring long-term monitoring.
- Understanding pathophysiological changes is crucial for predicting HCM patient outcomes.
- Historical clinical data provides valuable insights into disease progression.
Purpose:
- To evaluate the natural history and prognosis of hypertrophic cardiomyopathy (HCM) patients.
- To assess the utility of echocardiography in monitoring HCM progression and outcomes.
- To identify echocardiographic predictors of adverse events in HCM.
Summary:
- A retrospective analysis of 190 HCM patients (1968-1985) with a 4.0-year average follow-up revealed a 3.3% annual mortality rate, primarily from sudden death.
- Echocardiographic study of 70 patients showed that the ventricular tachycardia (VT) group initially had greater left ventricular end-diastolic dimension (LVDd) and reduced fractional shortening (FS).
- During follow-up, increased LVDd was observed in sudden death (SD) and VT groups, while the SD group showed decreased rapid filling rate (RFR) and atrial filling rate (AFR), suggesting echocardiography's role in prognosis.
Impact:
- Echocardiography is a valuable tool for assessing the natural history and prognosis of hypertrophic cardiomyopathy.
- Identifying specific echocardiographic changes can aid in risk stratification for HCM patients.
- This study underscores the importance of regular echocardiographic monitoring for HCM management.
Abstract:
To assess pathophysiological changes and prognoses in hypertrophic cardiomyopathy (HCM), the clinical courses of 190 patients with HCM between 1968 and 1985 were reviewed and analyzed. Their average follow-up period was 4.0 years. During the course of follow-up, 24 patients died of heart disease at annual mortality of 3.3%; 22 sudden death, and two congestive heart failure. Among the 190 cases, 70 were studied by echocardiography with an average follow-up period of 4.4 years. The subjects were categorized in three groups: 10 who died suddenly (SD group), 16 with ventricular tachycardia (VT group) and the remaining 44 without ventricular tachycardia (non-VT group). Initially, the VT group had significantly greater left ventricular end-diastolic dimension (LVDd), smaller % fractional shortening (FS), and normalized rapid felling rate (RFR) compared with the other two groups. However, there were no significant differences in the echocardiographic parameters between the SD and non-VT groups. During the follow-up period, no changes in echocardiographic parameters were observed in the non-VT group. However, LVDd was increased in both the SD and VT groups, and normalized RFR and atrial filling rate (AFR) were decreased in the SD group. These results suggested that close observations using echocardiography are useful for evaluating the natural history and prognoses of HCM.