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Prognostic Implications of Mitral Regurgitation Across Hypertrophic Cardiomyopathy Subtypes: A Report From REVEAL-HCM
Yuki Obayashi1,2, Takao Kato1, Hiroki Shiomi1
1Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Japan (Y.O., T.K., H.S., K.O.).
Insights
Mitral regurgitation (MR) in hypertrophic cardiomyopathy (HCM) does not worsen outcomes in hypertrophic obstructive cardiomyopathy (HOCM) or end-stage HCM (ES-HCM). However, moderate or greater MR significantly impacts prognosis in other HCM subtypes, necessitating tailored management strategies.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Mitral regurgitation (MR) is a common comorbidity in patients with hypertrophic cardiomyopathy (HCM).
- Limited data exist on the long-term prognostic impact and progression of MR across distinct HCM subtypes.
Purpose of the Study:
- To investigate the prognostic significance of moderate or greater MR in different HCM subtypes.
- To analyze the progression and regression of MR over time within these subtypes.
Main Methods:
- Retrospective analysis of 3602 patients with HCM from a Japanese multicenter registry.
- Comparison of outcomes based on MR severity (moderate or greater vs. mild or less) within hypertrophic obstructive cardiomyopathy (HOCM), end-stage HCM (ES-HCM), and other HCM subtypes.
- Longitudinal follow-up to assess all-cause death or heart failure hospitalization and MR severity changes.
Main Results:
- Prevalence of moderate or greater MR was highest in HOCM (36.3%), followed by ES-HCM (21.5%) and other HCM (8.5%).
- No significant difference in 5-year mortality or heart failure hospitalization was observed for moderate or greater MR in HOCM or ES-HCM.
- Moderate or greater MR was significantly associated with worse outcomes in other HCM subtypes (HR 1.45, P=0.01), with significant interaction (P=0.02).
- MR severity improved in HOCM, remained stable in ES-HCM, and worsened in other HCM over time.
Conclusions:
- Moderate or greater MR is not associated with adverse outcomes in HOCM or ES-HCM.
- Significant prognostic implications of moderate or greater MR exist in other HCM subtypes.
- HCM subtype-specific management of MR is crucial for optimizing patient outcomes.
Background:
Mitral regurgitation (MR) is a frequent comorbidity in patients with hypertrophic cardiomyopathy (HCM), which includes distinct subtypes with various characteristics. However, data on the long-term prognostic impact of MR and its progression or regression over time remain limited, particularly across individual HCM subtypes.
Methods:
Patients with HCM were retrospectively included from a Japanese multicenter registry and compared by MR severity (moderate or greater versus mild or less) within each subtype: hypertrophic obstructive cardiomyopathy (HOCM), end-stage HCM (ES-HCM), and other HCM (including nonobstructive, midventricular obstruction, and apical HCM).
Results:
Among 3602 patients (HOCM: n=837; ES-HCM: n=275; other HCM: n=2490), the prevalence of moderate or greater MR was highest in HOCM (36.3%), followed by ES-HCM (21.5%) and other HCM (8.5%). During a median follow-up of 5.3 (interquartile range, 2.1-9.3) years, the cumulative 5-year incidence of all-cause death or heart failure hospitalization was not significantly different between the moderate or greater MR and mild or less MR groups in HOCM (14.6% versus 12.4%; P=0.35) or ES-HCM (60.7% versus 54.7%; P=0.84). After adjustment for clinical covariates, no significant association was observed in either subtype (HOCM: hazard ratio, 1.13 [95% CI, 0.79-1.60], P=0.51; ES-HCM: hazard ratio, 0.84 [95% CI, 0.55-1.28], P=0.42). In contrast, in other HCM, moderate or greater MR was significantly associated with the higher 5-year cumulative incidence of all-cause death or heart failure hospitalization (34.2% versus 13.9%, P<0.001), which remained significant after adjustment, with a significant interaction (hazard ratio, 1.45 [95% CI, 1.09-1.91], P=0.01; Pinteraction=0.02). MR severity improved over time in HOCM, showed no clear change in ES-HCM, and worsened in other HCM (P<0.001, 0.46, and <0.001, respectively; Pinteraction <0.001).
Conclusions:
In patients with HCM, moderate or greater MR was not associated with worse outcomes in HOCM or ES-HCM, but had significant prognostic implications in other HCM subtypes, suggesting the need for HCM subtype-specific MR management.
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