What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertrophic cardiomyopathy (n=77). Intervention: Elevated CK-MB (≥2.5%) vs. Normal CK-MB (<2.5%). Primary outcome: Incidence of heart failure.

November 8, 2015Open Access

Elevated Cardiac Enzymes in Hypertrophic Cardiomyopathy Patients With Heart Failure　– A 20-Year Prospective Follow-up Study –

Q: What are the key findings of this study?

Persistent elevation of CK-MB (≥2.5%) in hypertrophic cardiomyopathy patients was associated with a higher incidence of heart failure (55% vs 9%) and heart failure deaths over a 20-year follow-up.

Key Result

Persistent elevation of CK-MB (≥2.5%) in hypertrophic cardiomyopathy patients was associated with a higher incidence of heart failure (55% vs 9%) and heart failure deaths over a 20-year follow-up.

Study Design

Type

Cohort (n=77)

Multicenter

Structured PICO

Does persistent elevation of cardiac enzymes predict adverse left ventricular remodeling and heart failure death in patients with hypertrophic cardiomyopathy?

Population

77 patients with hypertrophic cardiomyopathy (HCM)

Intervention

Elevated cardiac enzymes (CK-MB ≥2.5%, n=33)

Comparator

Lower cardiac enzymes (CK-MB <2.5%, n=44)

Outcome

Changes in left ventricular (LV) remodeling and development of heart failurehard clinical

Persistent elevation of cardiac enzymes, particularly CK-MB, in HCM patients is associated with progressive adverse LV remodeling and increased risk of heart failure death.

Main Result

Absolute Event Rate: 54.5% vs 9.1%

Limitations

CK isozymes were measured using cellulose acetate electrophoresis and fluorescence, a method that was discontinued in 1989, limiting the ability to collect a larger patient cohort.
High-sensitivity troponin T, a currently useful marker of myocardial injury, was not utilized at the time the study was initiated.

Abstract

BACKGROUND: To better understand the evolution of typical hypertrophic cardiomyopathy (HCM) to heart failure (HF), we investigated the relationship between serum biochemical abnormalities and changes in left ventricular (LV) remodeling. METHODS AND RESULTS: Seventy-seven HCM patients were followed for 20 years. Creatine kinase (CK), CK-MB, lactate dehydrogenase (LDH), LDH-1, troponin T and myosin light chain-1 (MLC-1) were measured. Abnormal CK-MB elevation was observed in 64% of HCM patients. LDH-1 was not significantly different compared with the control subjects. Troponin T elevation was observed in 3 HCM patients and MLC-1 elevation was not observed. According to median CK-MB, HCM patients were divided into 2 groups: group H (CK-MB ≥2.5%, n=33) and group L (CK-MB <2.5%, n=44). During the follow-up period in group H, LV end-diastolic dimension increased (P<0.0001), fractional shortening decreased (P<0.0004), and left atrial dimension increased (P<0.0001). The markers reflecting LV hypertrophy were significantly decreased. In group L, LV end-diastolic dimension increased (P<0.02) and left atrial dimension increased (P<0.0001). HF was observed in 18 patients in group H and in 4 in group L. There were 14 HF deaths in group H and 2 in group L, and 3 sudden cardiac deaths in group H. CONCLUSIONS: Persistent elevation of cardiac enzymes in HCM patients indicates ongoing myocardial injury, ultimately resulting in death by HF.

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Cite This Study

Hamada et al. (Sun,) conducted a cohort in Hypertrophic cardiomyopathy (n=77). Elevated CK-MB (≥2.5%) vs. Normal CK-MB (<2.5%) was evaluated on Incidence of heart failure. Persistent elevation of CK-MB (≥2.5%) in hypertrophic cardiomyopathy patients was associated with a higher incidence of heart failure (55% vs 9%) and heart failure deaths over a 20-year follow-up.

synapsesocial.com/papers/6a08aa939a6c4ba6e610c808 https://doi.org/https://doi.org/10.1253/circj.cj-15-0872