Low relative wall thickness (RWT <0.42) in HCM patients was associated with a 42% higher risk of all-cause death and a 67% higher risk of cardiovascular death.
Does baseline left ventricular geometry (RWT and LVMI) predict mortality and heart failure outcomes in patients with hypertrophic cardiomyopathy?
In patients with hypertrophic cardiomyopathy, low relative wall thickness and eccentric hypertrophy are associated with a higher risk of all-cause and cardiovascular mortality.
Tasa de eventos absoluta: 0% vs 0%
Abstract Background Hypertrophic cardiomyopathy (HCM) is a lifelong disease characterised by progressive changes in pathophysiology and morphology due to left ventricular (LV) remodelling. While most HCM patients exhibit mild symptoms and have long-term survival, approximately 15% progress to a dilated phase or end-stage, characterised by myocardial fibrosis, chamber dilation, and systolic dysfunction. The temporal progression of ventricular remodelling and its impact on clinical outcomes remain poorly understood. Purpose This study aimed to investigate the relationship between the baseline LV geometry, determined by relative wall thickness (RWT) and left ventricular mass index (LVMI), and the prognosis in HCM patients. The dynamic changes in the LV geometry over time were also analysed. Methods The Multicentre Registry to EValuate risk factors for disEase progression, sudden cArdiac death and adverse cLinical outcomes in patients with Hypertrophic Cardio Myopathy study (REVEAL-HCM) retrospectively enrolled 3,695 HCM patients. Echocardiographic data were collected at 1, 5, and 10 years. RWT was calculated as 2 times posterior wall thickness divided by LV end-diastolic diameter. Patients were classified into two groups: low RWT (0.42) and high RWT (≥0.42). Patients were further categorised into four groups: normal, concentric remodelling, concentric hypertrophy, and eccentric hypertrophy, based on LVMI hypertrophy criteria (female: ≤95 vs. 95 g/m²; male: ≤115 vs. 115 g/m²). The primary outcome was the all-cause death. We constructed multivariable Cox proportional hazards models including the following variables into the model: sex, age, body mass index, hypertension, history of ventricular tachycardia/ventricular fibrillation, history of syncope, history of atrial fibrillation, family history of HCM or sudden cardiac death, log-BNP, left ventricular outflow tract obstruction, and presence of an apical aneurysm. Results The mean age was 63.4±15.5 years, with 57.8% male. The mean RWT and LVMI at baseline were 0.49±0.16 and 132.1±42.9 g/m2. Over 10 years, RWT decreased progressively, indicating progressive relative LV dilatation and thinning of LV wall thickness (Figure 1). Patients in the low RWT group showed worse survival (p=0.006, Figure 2A) and a higher risk of all-cause death (unadjusted HR 95% CI, 1.31 1.08–1.59, p0.01; adjusted HR, 1.42 1.11–1.82, p0.01) than the high RWT group. The low RWT group showed a higher risk of cardiovascular death compared to the high RWT group (unadjusted HR1.53 1.19–1.98, p0.01; adjusted HR, 1.67 1.22–2.28, p0.01). The composite of all-cause death and heart failure hospitalisation was the worst in the eccentric hypertrophy group (p0.0001, Figure 2B). Conclusion LV geometry showed a trend towards dilatation over time in the entire HCM cohort. RWT and LV geometry determined by RWT and LVMI can predict the prognosis and stratify the risk of cardiovascular events in the patients with HCM.
Yoshitake et al. (Sat,) reported a other. Low relative wall thickness (RWT <0.42) in HCM patients was associated with a 42% higher risk of all-cause death and a 67% higher risk of cardiovascular death.