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Hypertrophic cardiomyopathy: can we predict dysrhythmic events?
Session:
Painel 3 - Imagiologia Cardiovascular 4
Speaker:
Nelson P. Cunha
Congress:
CPC 2020
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.3 Cardiac Magnetic Resonance
Session Type:
Posters
FP Number:
---
Authors:
Nelson P. Cunha; Joana Rigueira; Rui Plácido; Tiago Graça Rodrigues; Inês Aguiar Ricardo; Paula Campos; Fausto José Pinto; Ana G. Almeida
Abstract
<p><strong>Introduction:</strong> In hypertrophic cardiomyopathy (HCM), there is a significant contribute of dysrhythmic events (DE) for the burden of morbidity and mortality of the disease. </p> <p>The aim of this study is to assess the arrhythmic profile of HCM patients (pts) and predictors of DE.</p> <p><strong>Methods:</strong> Retrospective single-center study of 36 consecutive pts with HCM defined by wall thickness ≥15 mm in ≥1 LV myocardial segments in CMR; patients with history of uncontrolled hypertension (HTN) and significant valvular disease were excluded. </p> <p>Demographic, clinical, CMR data and outcomes were analyzed. For statistical analysis, chi-square and Mann-Whitney tests were used, with prediction of DE (atrial fibrillation (AF); ventricular tachycardia (VT)) and implantation of cardioverter defibrillator (ICD)) with binary logistic regression model. </p> <p><strong>Results: </strong></p> <p>The median age was 62.5 years (IQR: 49,5-74,8), 64% were male. 69% had controlled HTN, 46% dyslipidemia and 23% diabetes; family history (FH) of sudden cardiac death and HCM occurred in 16% and 46%, respectively. 9% presented with syncope, 21% with palpitations and 12% with angina. Previous history of AF was present in 12% pts. Genetic study was available in 42% pts, mutations were identified in 25% (TNNT2: 8,3%; MYBPC3:5.6%).</p> <p>During a mean follow-up of 496±338 days, new onset of AF was found in 26%, VT episodes in 20%, ICD implantation in 29% and 3% died.</p> <p>On ECG evaluation, an intraventricular disturbance conduction was found in 33% of pts and T wave inversion in 39%. </p> <p>On CMR, most pts had hypertrophy of septal wall (81%), while 11% had apical, 3% anterior-wall and 6% lateral-wall. SAM was present in 28% and LVOTO in 33%. 69% of the patients had LGE (midwall: 61%, subendocardial: 11%, subepicardic: 3%, LVH area: 47%, RV/LV insertion points: 25%, other: 19.4%).</p> <p>There was no associations of clinical data and AF. In univariate analysis, SAM (OR 5.25, CI95% 1.02-26.9, p=0.047), LVOTO (OR 6.7, CI95% 1.27-35.0, p=0.025), distribution of LGE on other segments than RV/LV insertion points (OR 9.6, CI95% 1.36-67.6, p=0.023) and absence of T-wave inversion (OR 0.17, CI95% 0.033-0.937, p=0.042), predicted AF. The absence of T-wave inversion was the only independent predictor of AF in our population (OR 0.073, CI95% 0.006-0.949, p=0.045). </p> <p>Also, we found that AF predicted VT (OR 6.13, CI95% 1.032-36.45, p=0.046) in univariate analysis and was an independent predictor for ICD (OR 9.6, CI95% 1.26-67.59, p=0.023).</p> <p>There were no independent predictors of ventricular arrythmias. AF was a predictor of composite outcome (death, heart failure and thromboembolic events) in our population (OR 6.3 CI95% 1.3-31.1, p=0.024).</p> <p><strong>Conclusion: </strong>In our population, T-wave characteristics, SAM, LVOTO and LGE distribution were predictors of AF. AF was an independent predictor for ICD implantation. These findings could be used for risk assessment and improve AF monitoring in HCM but larger studies are needed.</p>
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