Clinical Study Of Pulmonary Hypertension In Patients With Hypertrophic Obstructive Cardiomyopathy

Objective:The aim of this study was to explore the clinical characteristics and risk factors of pulmonary hypertension(PH)in patients with obstructive hypertrophic cardiomyopathy(HCM).Methods:A total of 356 patients admitted in Fuwai hospital and diagnosed with obstructive hypertrophic cardiomyopathy were included in our study.Proportion and severity of PH were depicted.The study population was divided into two groups(PH group and control group).Risk factors of pulmonary hypertension for patients with obstructive HCM were assessed by multivariate logistic regression analysis.Results:Multivariate logistic regression analysis indicated that female(OR=2.70,95%CI 1.32～5.54,P<0.01),higher gradient of left ventricular outflow tract or midventricular(OR=1.02,95%CI 1.01～1.03,P<0.01),history of atrial fibrillation(OR=2.81,95%CI 1.13～6.98,P=0.03)and moderate or severe mitral regurgitation(OR=5.16,95%CI 2.53～10.54,P<0.01)were independent risk factors of PH.Stratification according to sex showed that only moderate or severe mitral regurgitation(OR=9.69,95%CI 3.03～30.93,P<0.01)was independent risk factors of PH for male patients;While history of atrial fibrillation(OR=4.31,95%CI 1.2～15.51,P=0.03),moderate or severe mitral regurgitation(OR=3.06,95%CI 1.19～7.88,P=0.02),higher gradient of left ventricular outflow tract or midventricular(OR=1.02,95%CI 1.01～1.03,P<0.01)and larger left atrial dimension(OR=1.09,95%CI 1.01～1.17,P=0.03)were independent risk factors of PH for female patients.Risk factors were similar between the mild PH group and moderate to severe PH groups.Conclusion:Independent risk factors for PH in obstructive hypertrophic cardiomyopathy patients are female,higher gradient of left ventricular outflow tract or midventricular,history of atrial fibrillation and moderate or severe mitral regurgitation.Background and Objective:Left heart disease such as heart failure with preserved ejection fraction,mitral valve disease and also hypertrophic cardiomyopathy may result inelevated left atrial filling pressures and subsequent pulmonary hypertension(PH).However,the characterization and implications of PH in obstructive HCM has not been investigated before among Chinese patients.The purpose of this study was to evaluate the prevalence,clinical profile and outcome of myectomy for obstructive HCM patients with pulmonary hypertension.Methods:From March 2011 and March 2016,325 Chinese patients with documented obstructive HCM undergoing septal myectomy in Fuwai Hospital were enrolledin our study.Pulmonary artery systolic pressure(PASP)was assessed by echocardiography before surgery,and the cutoff value for PH was defined as PASP>35mmHg.Results:The proportion of PH was 13.8%(45cases),the median pulmonary artery systolic pressure was 43(40,51)mmHg.Compared with patients without pulmonary hypertension,patients with PH were mainly female and older,had a greater prevalence of atrial fibrillation,higher cardiac function grade of NYHA,higher left ventricular outflow tract or midventricular gradient,and larger left atria.With a median follow-up of 20.5 months,echocardiography results show that the PASP of patients with PH decreased to 30(28,34)mmHg.9/13 patients with moderate or severe PH and 27/32 patients with mild PH returned to normal,while 5/32 patients with mild PH remained a PASP>35mmHg.On the other hand,there was no statistically significant difference in composite of all-cause mortality and cardiovascular hospitalization post myectomy between patients with PH and patients without.Conclusion:Septal myectomy can relieve pulmonary hypertension in patients with obstructive hypertrophic cardiomyopathy,and the composite end of myectomy for patients with PH seems no difference compared to patients without PH.Background and Objective:Patients with obstructive hypertrophic cardiomyopathy(HCM)have an increased risk of heart failure and cardiovascular death,and myectomy can relieve symptoms and improve cardiac functional class.We aimed to explore the association between soluble ST2(sST2)and galectin-3(Gal-3)levels and outcomes after myectomy in obstructive HCM.Methods:Consecutive obstructive HCM patients who underwent myectomy in Fuwai hospital from 2011 to 2016 were included.We used Cox regression model to evaluate predictors of the end point.Results:Enzyme immunoassay results showed that sST2 and Gal-3 levels were significantly higher in obstructive HCM patients(both P<0.001).During follow-up,the incidence of composite of all-cause mortality and cardiovascular hospitalization in the low and high sST2 was 13%vs.9%(P=0.58).Also,there was no increased risk for composite of all-cause mortality and cardiovascular hospitalization(7%vs.15%;P =0.25)at high Gal-3 group.Cox regression analysis suggested neither logsST2 nor log-Gal-3 independently predicted composite endpoint of all-cause mortality and cardiovascular hospitalization(both P>0.05).On the contrary,On the contrary,age(adjusted HR,1.06;95%CI:1.02-1.11,P<0.01)and male(adjusted HR,2.92;95%CI:1.02-8.36,P<0.05)were identified as independent factors for endpoint post myectomy by multivariate Cox regression analysis.Conclusion:In patients with obstructive hypertrophic cardiomyopathy,plasma sST2 and Gal-3 levels were increased.However,sST2 and Gal-3 did not predict clinical outcomes,while advanced age and male predicted composite of all-cause mortality and cardiovascular hospitalization post myectomy.