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Prognostic Implication of Left Ventricular Global Longitudinal Strain in Patients With Hypertrophic Cardiomyopathy
Soongu Kwak1,2, Jihoon Kim3, Chan-Soon Park1,2
1Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Insights
Hypertension in hypertrophic cardiomyopathy (HCM) patients is linked to worse outcomes. Lower left ventricular global longitudinal strain (LV-GLS) in these patients independently predicts adverse cardiovascular events, highlighting its prognostic value.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Clinical Prognostics
Background:
- The prognostic significance of coexisting hypertension in hypertrophic cardiomyopathy (HCM) patients remains unclear.
- Hypertension is a common comorbidity in HCM, potentially influencing disease progression and outcomes.
Purpose of the Study:
- To investigate the association between left ventricular global longitudinal strain (LV-GLS) and adverse cardiovascular (CV) events in HCM patients with coexisting hypertension.
- To determine if LV-GLS provides prognostic information in this specific patient population.
Main Methods:
- A cohort of 1,139 HCM patients from two tertiary referral centers was analyzed.
- Cardiovascular events were defined as a composite of CV death, heart failure, and stroke.
- LV-GLS was measured in a core laboratory, and outcomes were assessed over a median follow-up of 6.6 years.
Main Results:
- Of 1,139 HCM patients, 522 (45.8%) had hypertension. These patients were older, had more comorbidities, and exhibited lower LV-GLS (13.7% vs. 14.4%, p=0.001).
- Patients with hypertension had a significantly higher incidence of CV events (p=0.005).
- Lower LV-GLS was independently associated with increased CV event risk in hypertensive HCM patients (aHR, 1.07 per 1% decrease; p=0.013). Patients with both hypertension and low LV-GLS (<13.1%) faced the highest risk (aHR, 1.60; p=0.044).
Conclusions:
- HCM patients with hypertension are older, have more CV comorbidities, and present with reduced LV-GLS.
- LV-GLS is a crucial prognostic marker in patients with both HCM and hypertension, aiding in risk stratification.
Background And Objectives:
The prognostic implication of coexisting hypertension in patients with hypertrophic cardiomyopathy (HCM) is poorly defined. This study aimed to evaluate the association between left ventricular global longitudinal strain (LV-GLS) and adverse cardiovascular (CV) events in patients with HCM and coexisting hypertension.
Methods:
We analyzed consecutive patients with HCM from 2 tertiary HCM referral centers. The primary outcome was CV events, defined as a composite of CV death, heart failure, and stroke. All LV-GLS measurements were conducted in a core laboratory.
Results:
Of 1,139 patients with HCM, 522 (45.8%) had hypertension. Patients with hypertension were older, had more CV comorbidities, and showed a lower LV-GLS (13.7% vs. 14.4%, p=0.001). During a median 6.6-year follow-up, 155 CV events occurred, with a significantly higher crude incidence in patients with hypertension than in those without (p=0.005). Lower LV-GLS was independently associated with a higher risk of CV events in patients with hypertension (per 1% decrease in LV-GLS, adjusted hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.01-1.13; p=0.013). When stratified by four groups based on hypertension and LV-GLS, CV events most frequently occurred in patients with both hypertension and a lower LV-GLS (<13.1%), with a significantly higher risk compared to those without hypertension and a higher LV-GLS (≥13.1%) (adjusted HR, 1.60; 95% CI, 1.01-2.54; p=0.044).
Conclusions:
Patients with HCM and coexisting hypertension were older, had more prevalent CV comorbidities, and exhibited a lower LV-GLS compared to those without hypertension. LV-GLS provides important prognostic information in patients with both HCM and hypertension.
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