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Prevalence and clinical impact of latent obstruction in hypertrophic cardiomyopathy
Session:
Posters - F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Speaker:
Ana Filipa Abreu Cardoso
Congress:
CPC 2021
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.2 Myocardial Disease – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Ana Filipa Cardoso; Mário Rui Lourenço; Pedro Von Hafe; Geraldo Dias; Tamara Pereira; Mariana Tinoco; Marina Fernandes; Olga Azevedo; António Lourenço
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif"><strong>BACKGROUND: </strong>Hypertrophic cardiomyopathy (HCM) is characterized by varying degrees of left ventricular outflow tract obstruction (LVOTobs). We aim to define the prevalence, clinical profile and impact of LVOTobs under physiological exercise in HCM patients (pts).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif"><strong>METHODS:</strong> Single center retrospective study of consecutive HCM pts without LVOTobs at rest (resting gradient <30mmHg), referred for exercise stress echocardiogram (ESE) between 2015 and 2019. Significative latent obstruction was defined as a LVOT gradient ≥50 mmHg during exercise or at early recuperation. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif"><strong>RESULTS: </strong>A total of 56 pts were included (64% men, mean age 57±11 years, 61% septal HCM). The majority of pts (47; 84%) were in NYHA I functional class, 20 (36%) had history of syncope or pre-syncope (S/pS) and 7 (13%) had an implantable cardioverter defibrillator (ICD).</span></span><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif"> Twelve (21%) pts had systolic anterior motion (SAM) of the mitral valve at rest. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif">Thirty-five (63%) pts performed ESE under beta-blocker (BB) therapy. Mean exercise time was 8±3 min. During ESE, 2 (4%) pts developed a LVOT gradient between 30 to 50 mmHg and 17 pts (30%) developed a significative LVOTobs gradient (mean 85±18 mmHg).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif">Pts with significative latent LVOTobs had more previous complaints of S/pS (59% vs 26%, p=.017), a tendency for a higher NYHA functional class (p=.082) and were more frequently on BB therapy (82% vs 18%, p=.043). Mean septum thickness was similar between groups (17±0.7 vs 16±0.6 mm, p=.536). The presence of SAM at rest was more frequent in the significative latent LVOTobs pts (p<.001). No differences were noted in exercise tolerance (p=.526).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif">During a median follow-up of 43 (IQR 15-53) months, 7 (41%) pts with significative latent LVOTobs had a pre-syncope, 3 (18%) were diagnosed with atrial fibrillation and 2 (12%) had a cardiovascular admission<em>.</em> There was up-titration/initiation of BB therapy in 5 (29%) pts, referral for septal myectomy in 3 (18%) and ICD implantation for primary prevention in 3 (18%) pts. No proper ICD shocks, sustained ventricular arrythmias or deaths occurred. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif">Comparing significative latent to non LVOTobs pts, the first ones had more ICD implantation (log rank p =.04) and performed a surgical myectomy more frequently (log rank p= .018) during the follow-up.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif"><strong>CONCLUSION: </strong>In our study, significative latent LVOTobs was observed in 30% of pts. Its presence can have clinical implications in HCM pts approach and should be suspected in more symptomatic pts and when SAM is present at rest.</span></span></p>
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