Analysis Of The Mid-term Prognosis Of Patients With Obstructive Hypertrophic Cardiomyopathy After Myocardial Resection

Background:Several studies attempted to predict cardiovascular events in patients with obstructive hypertrophic cardiomyopathy after surgical myectomy,however there was no consistent conclusion.This study aims to ascertain the prognostic predictors in hypertrophic cardiomyopathy patients underwent surgical myectomy.Methods:We recruited and followed 472 consecutive drug-refractory adult obstructive hypertrophic cardiomyopathy patients who have undergone surgical myectomy and preoperative cardiovascular magnetic resonance examination at Fuwai Hospital from June 2011 to April 2016.The primary endpoint was cardiovascular death.The secondary endpoint was non-fatal cardiovascular events.Composite endpoints include both the primary and secondary endpoint.Results:After a mean follow-up of 2.5±1.4 years(range 1 to 6 years),10 patients met the primary endpoint with 1-year,2-year and 3-year event rate was 0.7%,1.3%and 3.2%,respectively.Meanwhile,53 patients met the composite endpoints with 1-year,2-year and 3-year event rate was 4.4%,9.6%and 13.5%,respectively.Multivariable Cox regression analysis demonstrated that extensive late gadolinium enhancement(hazard ratio,11.80;95%confidence interval,1.38-100.95;P=0.024)was the only independent predictor of primary endpoint,while preoperative atrial fibrillation(hazard ratio,2.04;95%confidence interval,1.10-3.78;P1=0.024)and increased maximal left atrial volume(hazard ratio,2.64;95%confidence interval,1.46-4.79;P=0.001)were independent indicators of composite endpoints.Furthermore,the same two parameters can predict the secondary endpoints independently.Conclusions:Extensive late gadolinium enhancement is the only independent predictor for cardiovascular death,while non-fatal cardiovascular events can be predicted by preoperative atrial fibrillation and increased maximal left atrial volume.Background:This study aims to assess the impact of morphological type on the prognosis of obstructive hypertrophic cardiomyopathy patients who underwent myectomy.Method:We recruited 469 obstructive hypertrophic cardiomyopathy patients refractory to medicinal treatment who have undergone surgical myectomy at a national wide referral center.All patients were divided into three groups based a morphological classification of left ventricle hypertrophy and were followed by telephone every year.The primary endpoints were sudden cardiac death,aborted sudden cardiac death and death due to heart failure or stroke.The secondary endpoints were non-fatal cardiovascular events.Results:Typical hypertrophy limited to basal septum,hypertrophy of the whole ventricular septum and hypertrophy involved whole left ventricle presented in 248(52.9%),141(30.1%)and 80(17.0%)patients respectively.During the follow-up of 2.5±1.4 years after myectomy,ten(2.1%)and 43(9.2%)patients met the primary endpoint and secondary endpoints respectively.The maximal thicknesses of the ventricle septum,and the left ventricle mass and the presence of extensive late gadolinium enhancement were lower in patients with hypertrophy limited to basal septum than in other patients.The patients with the basal septum hypertrophy showed better survival after myectomy compared to other patients.For the secondary and composite endpoints,there was no significant difference between three groups.Conclusion:These patients with hypertrophy limited to the basal septum represented one special clinical subtype of obstructive hypertrophic cardiomyopathy showing better clinical outcomes,while diffuse hypertrophy of the ventricular septum and free wall indicated lower survival after surgical myectomy.Background:This study aims to investigate the impact of left atrium remodeling on postoperative atrial fibrillation(POAF)and clinical outcome in hypertrophic cardiomyopathy(HCM)patients who underwent myectomy.Methods:A total of 494 consecutive HCM patients with preoperative cardiac magnetic resonance testing who underwent myectomy at Fuwai Hospital from June 2011 to June 2016,were collected.All patients received continuous electrocardiogram monitoring during the postoperative hospital stay.Composite cardiovascular events were recorded,including death,stroke,arterial embolism,and onset of congestive failure requiring in-hospital intervention.Results:During the hospital stay,55(12.9%)patients occurred POAF in 427 patients without preoperative atrial fibrillation(AF).Multivariable logistic regression analysis showed that old age(p<0.001;OR,3.663;95%CI,1.940-6.915),elevated maximal left atrium volume(LAV)(p = 0.004,OR,2.224;95%CI,1.291-3.830)and impaired left atrium ejection fraction(LAEF)(p = 0.031;OR,1.675;95%CI,1.048-2.674)were associated with the incidence of POAF.During the follow-up of 2.4±1.4 years,56 patients suffered from composite cardiovascular events.The survival without composite cardiovascular events of patients with POAF was lower than that of patients maintaining sinus rhythm(p<0.001),but similar to those having preoperative AF(p=0.832).Furthermore,the event-free survival of patients with elevated LAV,decreased LAEF and old age was also lower(p<0.05).Conclusion:Elevated LAV and decreased LAEF were independently related to POAF onset in HCM patients who underwent myectomy.POAF was characteristic of one particular subtype of HCM patients with worse outcome similar to those with preoperative AF.