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Patient reported outcomes in obstructive hypertrophic cardiomyopathy undergoing myectomy: Results from SPIRIT-HCM
Albree Tower-Rader1, Natalie Szpakowski2, Zoran B Popovic2
1Hypertrophic Cardiomyopathy Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, United States of America; Department of Cardiovascular Medicine, Massachusetts General Hospital, Boston, MA, United States of America.
Insights
Surgical myectomy significantly improves quality of life in obstructive hypertrophic cardiomyopathy (oHCM) patients. While patient-reported outcomes (PROs) strongly correlate with each other, discordance with New York Heart Association (NYHA) class was noted.
Area of Science:
- Cardiology
- Patient-Reported Outcomes Research
Background:
- Obstructive hypertrophic cardiomyopathy (oHCM) significantly impacts patient quality of life (QOL).
- Patient-reported outcomes (PROs) are crucial for assessing QOL in oHCM.
- Understanding the relationship between PROs, physician-reported metrics, and treatment outcomes is essential.
Purpose of the Study:
- To investigate the correlation between various PROs in symptomatic oHCM patients.
- To examine the association of PROs with the New York Heart Association (NYHA) functional class.
- To evaluate the changes in PROs, functional capacity, and obstruction following surgical myectomy.
Main Methods:
- A prospective study involving 173 symptomatic oHCM patients undergoing surgical myectomy.
- PROs including KCCQ, PROMIS, DASI, and EQ-5D were collected at baseline and 12-month follow-up.
- NYHA class, 6-minute walk test (6MWT), and peak left ventricular outflow tract gradient (PLVOTG) were also assessed.
Main Results:
- Significant correlations were observed between different PROs (r-values 0.66-0.92, p<0.001).
- Modest correlations were found between PROs and 6MWT/PLVOTG (r-values 0.2-0.5, p<0.01).
- Surgical myectomy led to significant improvements in PROs, NYHA class, 6MWT distance, and PLVOTG at 12 months.
Conclusions:
- Surgical myectomy effectively improves PROs, LVOT obstruction, and functional capacity in symptomatic oHCM patients.
- A high degree of correlation exists among various PRO measures.
- A notable discordance was observed between patient-reported outcomes and NYHA class.
Background:
Patient reported outcomes (PRO) can assess quality of life (QOL) in obstructive hypertrophic cardiomyopathy (oHCM). In symptomatic oHCM patients, we sought to study the correlation between various PROs, their association with physician reported New York Heart Association (NYHA) class and changes after surgical myectomy.
Methods:
We prospectively studied 173 symptomatic oHCM patients undergoing myectomy (age 51 years, 62% men) between 3/17-6/20. PROs, including a) Kansas City Cardiomyopathy Questionnaire (KCCQ) summary score b) Patient-Reported Outcomes Measurement Information System [PROMIS] c) Duke Activity Status Index [DASI] & d) European QOL score [EQ-5D], along with NYHA class, 6-min walk test (6MWT) distance and peak left ventricular outflow tract gradient (PLVOTG) were recorded at baseline and 12 month follow-up.
Results:
The median baseline PRO scores (KCCQ summary, PROMIS physical, PROMIS mental, DASI, EQ-5D) were 50, 67, 63, 25, 50, 37, 44, 25 and 0.61, respectively; 6MWT distance was 366 m. There were significant correlations between various PROs (r-values between 0.66 and 0.92, p < 0.001), but only modest correlations with 6MWT and provokable LVOTG (r-values between 0.2 and 0.5, p < 0.01). At baseline, 35-49% patients in NYHA class II had PROs worse than median, while 30-39% patients in NYHA Class III/IV had PROs better than median. At follow-up, a 20 point improvement in KCCQ summary score was observed in 80%, 4 point improvement in DASI score in 83%, 4 point improvement in PROMIS physical score 86% and a 0.04 point improvement in EQ-5D in 85%); along with improvements in NYHA class (67% in Class I) and peak LVOTG (median 13 mmHg) and 6MWT (median distance 438 m).
Conclusions:
In a prospective study of symptomatic oHCM patients, surgical myectomy significantly improved PROs, LVOT obstruction, and functional capacity, with a high correlation between various PROs. However, there was high rate of discordance between PROs and NYHA class.
Study Registration:
ClinicalTrials.gov: NCT03092843.
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