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Published on: April 30, 2020
Comparison Between Heart Failure Without Left Ventricular Systolic Dysfunction and Progression to End-Stage in
Shoko Nakagawa1, Atsushi Okada1, Yuki Irie1
1Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center.
Insights
Heart failure without left ventricular systolic dysfunction is more common in hypertrophic cardiomyopathy patients than developing it or sudden cardiac death. These conditions have distinct predictors and minimal overlap.
Area of Science:
- Cardiology
- Cardiovascular Research
- Hypertrophic Cardiomyopathy Research
Background:
- Heart failure (HF) in hypertrophic cardiomyopathy (HCM) without left ventricular systolic dysfunction (LVSD) lacks clear understanding.
- Predictors for HF without LVSD, progression to LVSD, and sudden cardiac death (SCD) in HCM are not fully elucidated.
Purpose of the Study:
- To investigate the incidence and predictors of HF hospitalization without LVSD in HCM patients with preserved ejection fraction.
- To compare these outcomes with the development of LVSD and SCD.
- To identify distinct risk factors for different HF trajectories in HCM.
Main Methods:
- Retrospective analysis of 330 HCM patients with left ventricular ejection fraction (LVEF) ≥50%.
- Evaluation of HF hospitalization without LVSD and development of LVSD as primary outcomes.
- Multivariable analysis to identify predictors for each outcome during a median 7.3-year follow-up.
Main Results:
- HF hospitalization without LVSD occurred in 18.8% of patients, higher than developing LVSD (10.9%) or SCD (8.8%).
- Only 19.4% of patients who developed LVSD had prior HF hospitalization without LVSD.
- Predictors for HF without LVSD (age, atrial fibrillation, prior HF, BNP) differed significantly from those for developing LVSD (male sex, lower LVEF, lower LVOT gradient, higher TR gradient).
Conclusions:
- In HCM patients with LVEF ≥50%, HF hospitalization without LVSD is more frequent than developing LVSD or SCD.
- The overlap between HF without LVSD and progression to LVSD is limited.
- HF without LVSD and developing LVSD in HCM have distinct clinical predictors.
Background:
The incidence and prognostic predictors of heart failure (HF) without left ventricular systolic dysfunction (LVSD) in hypertrophic cardiomyopathy (HCM), particularly their differences in terms of developing LVSD (progression to end-stage) or sudden cardiac death (SCD), are not fully elucidated.
Methods And Results:
This study included 330 consecutive HCM patients with left ventricular ejection fraction (LVEF) ≥50%. HF hospitalization without LVSD and development of LVSD were evaluated as main outcomes. During a median follow-up of 7.3 years, the incidence of HF hospitalization without LVSD was 18.8%, which was higher than the incidence of developing LVSD (10.9%) or SCD (8.8%). Among patients who developed LVSD, only 19.4% experienced HF hospitalization without LVSD before developing LVSD. Multivariable analysis showed that predictors for HF hospitalization without LVSD (higher age, atrial fibrillation, history of HF hospitalization, and higher B-type natriuretic peptide concentrations) were different from those of developing LVSD (male sex, lower LVEF, lower left ventricular outflow tract gradient, and higher tricuspid regurgitation pressure gradient). Known risk factors for SCD did not predict either HF without LVSD or developing LVSD.
Conclusions:
In HCM with LVEF ≥50%, HF hospitalization without LVSD was more frequently observed than development of LVSD or SCD during mid-term follow-up. The overlap between HF without LVSD and developing LVSD was small (19.4%), and these 2 HF events had different predictors.
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