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Predictors of left ventricular dysfunction in hypertrophic cardiomyopathy: results from a nationwide registry
Session:
Posters (Sessão 4 - Écran 7) - Miocardiopatias hereditárias
Speaker:
Mariana Silva Brandão
Congress:
CPC 2023
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.7 Myocardial Disease - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Mariana S. Brandão; João Gonçalves Almeida; Paulo Fonseca; Rita Faria; Olga Sousa; Conceição Fonseca; Ricardo Fontes-Carvalho; on Behalf of The Portuguese Registry of Hypertrophic Cardiomyopathy (Pro-HCM) Investigators
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction: </strong>Progression of hypertrophic cardiomyopathy (HCM) with left ventricular (LV) dysfunction (HCM-LVSD) is associated with poor prognosis, with prevalence ranging from 5-10%. Identification of predictors of LVSD may improve risk stratification and prognostication in HCM.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Aim</strong>: To identify predictors of HCM-LVSD.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>Retrospective study including all HCM pts enrolled in a nationwide registry. HCM-LVSD group included pts with LV ejection fraction (LVEF) ≤50% at baseline and pts who developed LV dysfunction/dilated phenotype during follow-up. Multivariate logistic regression was performed to identify predictors of HCM-LVSD.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>1042 HCM patients (57.8% male, mean age at diagnosis 52 years) were included; 81 (8%) belonged to the HCM-LVSD group. HCM-LVSD pts were mostly male (60.5%) and tended to be older at the time of diagnosis than those without LVSD (55 vs 52 years, p=.054). HCM-LVSD pts were more often symptomatic (84.1% vs 65.2%, p<.001), with more functional impairment (New York Heart Association class III-IV: 18.5% vs 9.2%, p=.021). Atrial fibrillation (21.3% vs 8.6%, p<.001) and intraventricular conduction disturbances (28.6% vs 14.4%, p=.002) were more prevalent in HCM-LVSD pts. HCM-LVSD pts had higher baseline left atrium (LA) volumes (52 vs 39 ml, p=.001), lower LVEF (50 vs 67%, p<.001) and higher rates of mitral regurgitation (79.0% vs 65.1%, p=.011). Prevalence of obstructive HCM was lower in the HCM-LSVD group (25.3% vs 40.9%, p=.007). Presence of late gadolinium enhancement (92.6% vs 74.6%, p=.035) was more common in pts with LVSD. Baseline N-terminal pro–B-type natriuretic peptide was higher in HCM-LVSD (3839 vs 1281 pg/ml, p=.027). In HCM-LVSD pts, implantation of cardioverter-defibrillators for secondary prevention was more frequent (28.6% vs 6.4%, p=.002), as was the use of pacemaker (16.7% vs 7.0%, p=.002). During a mean follow-up of 5.3±6.1 years, hospitalization for HF (50.0% vs 11.3%) and all-cause mortality (12.3% vs 2.9%, p<.001) were more frequent in HCM-LVSD group. After multivariate analysis, higher LA volume (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01-1.05, p=.003) and nonobstructive HCM (OR 2.74, 95% CI 1.03-7.27, p=.043) were independent predictors of HCM-LVSD.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions: </strong>In this large nationwide cohort of HCM pts, prevalence of LVSD was 8%, in line with existing literature. In this cohort, larger LA volumes and nonobstructive HCM predicted progression to HCM-LVSD.</span></span></p>
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