Left atrial enlargement (HR 1.626; 95% CI 1.01-2.62) and LV mass index (HR 1.014; 95% CI 1.007-1.022) independently predicted new-onset heart failure symptoms in hypertrophic cardiomyopathy.
Cohort (n=276)
No
Do cardiovascular magnetic resonance imaging parameters predict new-onset heart failure symptoms in asymptomatic patients with hypertrophic cardiomyopathy?
Baseline CMR parameters, specifically left atrial enlargement and LV mass index, independently predict the development of new-onset heart failure symptoms in previously asymptomatic patients with hypertrophic cardiomyopathy.
Hazard Ratio: 1.626 (95% CI 1.01–2.62)
valor p: p=0.045
Abstract Background Hypertrophic cardiomyopathy (HCM) is a heritable cardiac disorder characterized by increased left ventricular (LV) wall thickness, often leading to heart failure (HF). HF represents a significant burden and is a challenging condition to diagnose in individuals with HCM. Cardiovascular magnetic resonance (CMR) imaging provides detailed insights into cardiac assessment, but its role in predicting new onset of HF symptoms in patients with HCM remains unknown. This study aimed to identify CMR predictors associated with the development of HF symptoms in individuals with HCM. Methods This study was a single center retrospective cohort study that included HCM patients treated at a tertiary referral center in the United States who underwent at least 1 CMR exam, had no HF symptoms at baseline CMR and had a minimum follow-up period of 1 year. Clinical data were collected by review of electronic medical records from 1998-2018. CMR data were collected by analysis of CMR images by blinded expert cardiac radiologist. The primary outcome was new onset of HF symptoms defined as NYHA class ≥ II at follow up. Kaplan-Meier analyses, and univariate and multivariate Cox proportional hazard analyses were performed. Results Of 1,462 patients diagnosed with HCM who had at least 1 CMR, 276 HCM patients without HF symptoms at baseline were included in the study cohort. Average age at CMR was 52.7 ± 17.7 years and 93 (33.3%) were female. Median maximum left ventricular wall thickness was 19 mm (IQR 17-22) with a median LV ejection fraction of 71% (IQR 66-77). Late gadolinium enhancement (LGE) was detected in 150 (56.2%) patients (60.7% had mild; 30.7% moderate; 8.6% severe). During a median follow-up period of 6.3 years, 93 patients developed HF symptoms (NYHA class II in 56 (60.2%); class III in 31 (33.3%); and class IV in 6 (6.5%). Multivariable analysis adjusted for age showed that LA enlargement (HR 1.626; 95% CI 1.01–2.62; p=0.045) and LV mass index (HR 1.014; 95% CI 1.007-1.022; p= 0.001) at initial CMR along with sex (HR 1.7; 95% CI 1.074–2.691; p=0.023) were independent predictors of new onset of HF symptoms in patients with HCM. Conclusions Nearly half of the patients with HCM developed HF symptoms within 6.3 years. Left atrial enlargement, LV mass index, and sex were independent predictors of new onset of HF symptoms in HCM patients. These findings emphasize the value of CMR in HF risk assessment, in providing insights in management and improving outcomes in patients with HCM.
Silva et al. (Sat,) conducted a cohort in Hypertrophic cardiomyopathy (n=276). Cardiovascular magnetic resonance imaging parameters (LA enlargement and LV mass index) was evaluated on New onset of HF symptoms defined as NYHA class ≥ II at follow up (HR 1.626, 95% CI 1.01-2.62, p=0.045). Left atrial enlargement (HR 1.626; 95% CI 1.01-2.62) and LV mass index (HR 1.014; 95% CI 1.007-1.022) independently predicted new-onset heart failure symptoms in hypertrophic cardiomyopathy.