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December 29, 2022HeartOpen Access

Prognosis of patients with hypertrophic cardiomyopathy and low-normal left ventricular ejection fraction

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Why the study?

It was unknown whether low-normal LVEF is associated with adverse outcomes in HCM or adds incremental predictive value to the conventional HCM SCD-risk model.

Does low-normal or reduced LVEF increase the risk of adverse outcomes in patients with hypertrophic cardiomyopathy?

Population

1858 patients with HCM from two tertiary hospitals

Comparison

Low-normal LVEF (50%–60%) and reduced LVEF (<50%) vs preserved LVEF (≥60%)

Design

Retrospective cohort study

Follow-up

Median 4.09 years

Key result

Reduced LVEF (<50%) was an independent predictor of sudden cardiac death/equivalent events with an adjusted HR of 5.214 compared to preserved LVEF in patients with hypertrophic cardiomyopathy.

Authors

YCYou‐Jung ChoiHKHyung‐Kwan KimIHIn‐Chang Hwang

Discussion

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Member takes

Overview

May warrant closer SCD surveillance in HCM with reduced LVEF; extends risk models but remains hypothesis-generating.

Study Design

Type

Cohort (n=1,858)

Multicenter

Yes

Structured PICO

Does low-normal or reduced LVEF increase the risk of adverse outcomes in patients with hypertrophic cardiomyopathy?

P
Population
1,858 patients with hypertrophic cardiomyopathy (HCM) from two tertiary hospitals, median age 60.0 years, 68.0% male. Key inclusion: end-diastolic maximal LV wall thickness ≥15 mm without abnormal loading conditions, or ≥13 mm in family members, or prior objective evidence if LVEF <50%.
I
Intervention
Low-normal LVEF (50%-60%) and reduced LVEF (<50%)
C
Comparator
Preserved LVEF (≥60%)
O
Outcome
Composite of sudden cardiac death (SCD), ventricular tachycardia/fibrillation, and appropriate implantable cardioverter-defibrillator shockscomposite

Main Result

Effect estimate: HR 5.214 (95% CI 1.574 to 17.274)

p-value: p=0.007

In patients with hypertrophic cardiomyopathy, low-normal LVEF (50%-60%) is an independent predictor of heart failure hospitalization and cardiovascular death, while reduced LVEF (<50%) strongly predicts sudden cardiac death.

Limitations

  • Retrospective study design could introduce selection bias.
  • Study population mainly consisted of Asian patients; results may not be generalizable.
  • Limited number of patients with LVEF <50% may affect statistical power.
  • Did not demonstrate serial changes in LVEF.

Cite This Study

Choi et al. (2022) conducted a cohort in Hypertrophic Cardiomyopathy (n=1,858). Reduced LVEF (<50%) was an independent predictor of sudden cardiac death/equivalent events with an adjusted HR of 5.214 compared to preserved LVEF in patients with hypertrophic cardiomyopathy.

synapsesocial.com/papers/6978067976a395df3f7c7e2dhttps://doi.org/10.1136/heartjnl-2022-321853
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