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Unveiling the role of systemic inflammation in hypertrophic cardiomyopathy - a new predictor of cardiovascular events
Session:
Comunicações Orais - Sessão 21 - Miocardiopatia hipertrófica
Speaker:
Inês Miranda
Congress:
CPC 2023
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.7 Myocardial Disease - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Inês Pereira De Miranda; Filipa Gerardo; Mariana Passos; Carolina Mateus; Joana Lima Lopes; Inês Fialho; Marco Beringuilho; David Roque; Carlos Morais; João Bicho Augusto
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><strong>Background:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"> Hypertrophic cardiomyopathy (HCM) is an important cause of major cardiovascular events. Appropriate risk stratification is still lacking, with some patients still being overtreated (risk of inappropriate ICD therapies and other ICD-related complications) while others undertreated (risk of sudden cardiac death). Inflammation could play a crucial role in risk stratification.</span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><strong>Objective:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"> To test systemic inflammation biomarkers in HCM patients to predict long-term cardiovascular events. </span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><strong>Methods:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"> We included all consecutive HCM patients seen at our institution in a 10-year period. We collected data regarding demographic and clinical aspects, as well as systemic inflammation markers such as erythrocyte sedimentation rate (ESR), C-related protein, ferritin and albumin (the latter an inverse/negative marker of inflammation). We analyzed the structural phenotype of HCM using echocardiography and cardiac MRI imaging. Our primary endpoint was a composite of cardiovascular events that included admission for acute/decompensated heart failure, malignant arrhythmia, cardiac syncope, cardiovascular or sudden cardiac death, myocardial infarction, ischemic stroke and/or complete heart block. </span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><strong>Results: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">A total of 106 HCM patients were included, 52 were male (49,1%), with a mean age of 70±16 years (range 27 - 95 years). Of note, median CRP levels across all patients were 0.45 (interquartile range 0.19-1.64)mg/dL and median ferritin values were 266 (interquartile range 97-316)ng/mL. The best regression model (using backwards conditional input method) was consistent with a role of CRP (odds ratio [OR] 0.60 [95% CI 0.37-1.00], p=0.048) and ferritin (OR 1.01 [1.00-1.01], p=0.049) as independent predictors of primary endpoint. Patients who had a cardiovascular event had significantly higher values of CRP (median 0.53 [0.18-1.78] vs 0.29 [0.20-1.00]mg/dL p=0.023) and ferritin (median 309 [76-276] vs 177 [155-477]ng/mL, p=0.032). </span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><strong>Conclusion:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"> Low-grade systemic inflammation is a predictor of cardiovascular events in HCM and likely plays a role in the pathogenesis of the disease. Given the unmet need for therapies in HCM, modulating this inflammatory response could be a novel useful treatment target.</span></span></span></p>
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