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Obstructive - Nonobstructive hypertrophic cardiomyopathy: differences and predictors

Onur Akhan1, Mehmet Kis2, Tuncay Guzel3

  • 1Cardiology Department, Bilecik Training and Research Hospital, Bilecik, Turkey.

Acta Cardiologica
|October 9, 2023
PubMed

Insights

Hypertrophic cardiomyopathy (HCM) can be obstructive or nonobstructive. ST segment depression, QT prolongation, and systolic anterior motion (SAM) are key predictors of obstruction in HCM patients.

Area of Science:

  • Cardiology
  • Genetics
  • Medical Diagnostics

Background:

  • Hypertrophic cardiomyopathy (HCM) is a prevalent genetic heart condition affecting 1/500 individuals.
  • HCM can lead to adverse outcomes, primarily due to left ventricular outflow tract obstruction.
  • Distinguishing between obstructive (Obs-HCM) and nonobstructive (Nonobs-HCM) forms is crucial for patient management.

Purpose of the Study:

  • To identify differences between obstructive and nonobstructive HCM.
  • To determine predictors of obstruction in HCM using electrocardiographic (ECG) and echocardiographic (ECHO) evaluations.
  • To correlate clinical, demographic, and biochemical characteristics with HCM obstruction.

Main Methods:

  • Subgroup analysis of the national 'LVH-TR study' including 60 HCM patients (23 obstructive, 37 nonobstructive).
  • Exclusion of patients with arrhythmias or conduction blocks.
  • Comparison of ECG and ECHO findings, alongside clinical and biochemical data, between obstructive and nonobstructive HCM groups.

Main Results:

  • Significantly higher Body Surface Area (BSA), ST-segment depression, QT/QTc durations, Left Ventricular Mass Index (LVMI), and Systolic Anterior Motion (SAM) rates were observed in obstructive HCM.
  • ST-segment depression, QT duration, LVMI, and SAM were significant predictors of obstruction in univariate analyses.
  • Multivariate and correlation analyses identified ST segment depression (rho=0.29), QT prolongation (rho=0.34), and SAM (rho=0.62) as independent predictors of obstruction.

Conclusions:

  • ST segment depression, QT prolongation, and SAM are significant predictors for obstruction in hypertrophic cardiomyopathy.
  • These ECG and ECHO findings provide valuable insights for differentiating and predicting obstruction in HCM.
  • The study's detailed comparisons will inform future research on HCM obstruction.
Abstract

Keywords:
Left ventricular hypertrophycardiomyopathycardiovascular imagingechocardiography

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