Prognosis Study Of Hypertrophic Cardiomyopathy

Background and Objectives:As reported,diagnostic age,gender,and presence of outflow tract obstruction have an impact on prognosis in patients with hypertrophic cardiomyopathy.The aim of this study was to compare the long-term outcome between apical hypertrophic cardiomyopathy(ApHCM)and asymmetric septal hypertrophic cardiomyopathy(ASHCM)after the exclusion of these factor.Methods:A total of 540 patients(270 with ApHCM and 270 with ASHCM)identified in a consecutive single-center cohort were retrospectively studied.The two groups were matched by diagnostic age,gender and the presence of outflow tract obstruction.Clinical characteristics and long-term outcomes were compared.Results:The mean follow-up duration in ASHCM and ApHCM were 6.6 ± 5.5 and 7.6 ±4.1 years,respectively.During follow-up,16 patients experienced cardiovascular death in the ASHCM group while 2 patients experienced cardiovascular death in the ApHCM group(6.3%vs.0.7%,p<0.01).Cardiovascular morbidity in the ASHCM and ApHCM groups were 39.9 and 18.5%(p<0.01).In the multivariate Cox regression analysis,late gadolinium enhancement(LGE,HR:9.98;95%CI:1.28-78.0;p=0.03)and unexplained syncope(HR:5.73;95%CI:1.9-17.2;p<0.01)were independent predictors for cardiovascular mortality.Unexplained syncope was independently associated with a higher risk for sudden cardiac death(HR:4.30;95%CI:1.2-15.3;p = 0.02).Conclusions:After eliminating the interference of diagnostic age,gender and outflow tract obstruction,ASHCM represented a worse prognosis with a higher incidence of cardiovascular mortality and morbidity than ApHCM.LGE was a strong predictor for cardiovascular death.Background and Objectives:Atrial fibrillation plays an important role in the clinical course and long-term prognosis of hypertrophic cardiomyopathy.Patients with hypertrophic cardiomyopathy and atrial fibrillation has high incidence of cardiovascular mortality and thromboembolism.In order to quantify the risk of thromboembolism in hypertrophic cardiomyopathy,a formula called "5-year risk prediction model of thromboembolism in hypertrophic cardiomyopathy" was proposed and proved to be more precise than the traditional CHA2DS2-VASc score in an European study.However,these results were based on European participants.Researches about Chinese patients with hypertrophic cardiomyopathy and atrial fibrillation were rare.This study was intended to investigate the incidence of thromboembolism and cardiovascular mortality in the largest Chinese cohort with hypertrophic cardiomyopathy and atrial fibrillation and compared the preciseness between the "5-year risk prediction model of thromboembolism in hypertrophic cardiomyopathy" and traditional CHA2DS2-VASc score.Methods:A total of 326 patients with hypertrophic cardiomyopathy and atrial fibrillation in Fuwai Hospital were consecutively enrolled from 2005 to 2014 in this retrospective study.Clinical characteristics were collected and long-term outcomes were analyzed.Results:During the follow-up period of 5.122±2.81 years,36 patients(14.57%)experienced thromboembolism events,including 32(12.96%)ischemic stroke and 4(1.62%)systemic embolism.The thromboembolism incidence of patients without anticoagulants was 2.53%/year.But in the 54 patients who were receiving anticoagulants,none experienced thromboembolism(0%,p=0.008).The "5-year risk prediction model of thromboembolism in hypertrophic cardiomyopathy" predicted thromboembolism with an area under the ROC curve of 0.648(95%CI:0.540 to 0.757;p=0.004),higher than the CHA2DS2-VASc score with an area under the ROC curve of 0.547(95%CI:0.450-0.644;p=0.369).After dividing into different risk groups according to the "5-year risk prediction model of thromboembolism in hypertrophic cardiomyopathy",patients in the high-risk group were more likely to experience thromboembolism event than patients in the low-medium risk group(5.23%vs 1.60%,p<0.01).While classified according to the CHA2DS2-VASc score,incidence of thromboembolism showed no statistical significance between high and low-medium risk groups(2.99%vs 2.08%,p=0.25).The annual cardiovascular mortality of hypertrophic cardiomyopathy patients with atrial fibrillation was 1.95%.Conclusions:Hypertrophic cardiomyopathy patients with atrial fibrillation had high incidence of thromboembolism and cardiovascular death.The "5-year risk prediction model of thromboembolism in hypertrophic cardiomyopathy",more precise than the CHA2DS2-VASc score,can be applied to distinguish high-risk patients of TE in Chinese HCM patients with AF.Anticoagulants could reduce the incidence of thromboembolism in this cohort.