September 21, 2023Open Access

Prognosis of Patients with Hypertrophic Obstructive Cardiomyopathy: A Multicenter Cohort Study with Data-Driven Propensity Score Matching Analysis

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertrophic Cardiomyopathy (n=1810). Intervention: Hypertrophic Obstructive Cardiomyopathy (HOCM) vs. Hypertrophic Nonobstructive Cardiomyopathy (HNCM). Primary outcome: All-cause mortality (p=0.22).

Resultado clave

Hypertrophic obstructive cardiomyopathy was not associated with a significant difference in all-cause mortality compared to hypertrophic nonobstructive cardiomyopathy in a propensity-matched cohort.

Diseño del estudio

Tipo

Cohort (n=1,810)

Multicéntrico

Sí

PICO

Población

Hypertrophic Cardiomyopathy (n=1,810)

Intervención / comparador

Hypertrophic Obstructive Cardiomyopathy (HOCM) vs Hypertrophic Nonobstructive Cardiomyopathy (HNCM)

Resultado principal

All-cause mortality, p=0.22

Resultado numérico

valor p: p=0.22

Limitaciones

Retrospective multicenter study with potential heterogeneity among the 13 tertiary hospitals
Excluded patients who underwent alcohol septal ablation and septal myectomy surgery
Not all patients had a Valsalva maneuver, potentially leading to misdiagnosis of labile-obstruction as non-obstruction
Missing data on the degree of LVOT gradient prevented further analysis of its association with prognosis
Medications were only recorded during in-hospital treatment with no follow-up data available

Resumen

Background: Hypertrophic obstructive cardiomyopathy (HOCM) patients are reported to have a potential risk of sudden cardiac death (SCD); however, HCM with left ventricular outflow tract (LVOT) obstruction, which is regarded as a risk indicator of SCD, is doubtful since the LVOT gradient is dynamic and may be confounded by various environmental factors and routine activities. The purpose of this study was to explore the clinical prognosis of HOCM through a multicenter cohort study with data-driven propensity score matching (PSM) analysis. Methods: The cohort included 2268 patients with HCM from 1996 to 2021 in 13 tertiary hospitals. In the present study, we excluded 458 patients who underwent alcohol septal ablation (ASA) and septal myectomy (SM) surgery so 1810 HCM patients were eventually included. We developed a data-driven propensity score using 24 demographic and clinical variables to create 1:1 propensity-matched cohorts. A Cox proportional hazard regression model was constructed to assess the effect of HOCM on mortality. Results: = 0.48) between patients with HOCM and hypertrophic nonobstructive cardiomyopathy (HNCM), and according to the Cox proportional hazard regression model, LVOT obstruction was not a risk predictor in patients with HCM. Conclusions: In both matched and unmatched cohorts, there were no significant differences in clinical prognosis between HOCM and HNCM patients, and LVOT obstruction was not an independent risk predictor of prognosis in patients with HCM. Clinical Trial Registration: ChiCTR1800017330.

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