What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertrophic Cardiomyopathy (n=1858). Primary outcome: Composite of sudden cardiac death, documented ventricular tachycardia/fibrillation, appropriate ICD shocks (HR 5.214, 95% CI 1.574 to 17.274, p=0.007).

What does this research mean for the field?

Reduced left ventricular ejection fraction (<50%) is an independent predictor of sudden cardiac death/equivalent events in patients with hypertrophic cardiomyopathy. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

December 29, 2022HeartOpen Access

Prognosis of patients with hypertrophic cardiomyopathy and low-normal left ventricular ejection fraction

Q: What are the key findings of this study?

Reduced LVEF (<50%) was an independent predictor of sudden cardiac death/equivalent events with an adjusted HR of 5.214 compared to preserved LVEF in patients with hypertrophic cardiomyopathy.

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Key result

Reduced LVEF in HCM is linked to ~421% higher SCD risk versus preserved LVEF.

HR 5.214
95% CI 1.574 to 17.274
P=0.007
n=1,858

Why the study?

It was unknown whether low-normal LVEF is associated with adverse outcomes in HCM or adds incremental predictive value to the conventional HCM SCD-risk model.

Does low-normal or reduced LVEF increase the risk of adverse outcomes in patients with hypertrophic cardiomyopathy?

Study Design

Type

Cohort (n=1,858)

Multicenter

Yes

Structured PICO

Does low-normal or reduced LVEF increase the risk of adverse outcomes in patients with hypertrophic cardiomyopathy?

Population

1,858 patients with hypertrophic cardiomyopathy (HCM) from two tertiary hospitals, median age 60.0 years, 68.0% male. Key inclusion: end-diastolic maximal LV wall thickness ≥15 mm without abnormal loading conditions, or ≥13 mm in family members, or prior objective evidence if LVEF <50%.

Intervention

Low-normal LVEF (50%-60%) and reduced LVEF (<50%)

Comparator

Preserved LVEF (≥60%)

Outcome

Composite of sudden cardiac death (SCD), ventricular tachycardia/fibrillation, and appropriate implantable cardioverter-defibrillator shockscomposite

Main Result

Effect estimate: HR 5.214 (95% CI 1.574 to 17.274)

p-value: p=0.007

In patients with hypertrophic cardiomyopathy, low-normal LVEF (50%-60%) is an independent predictor of heart failure hospitalization and cardiovascular death, while reduced LVEF (<50%) strongly predicts sudden cardiac death.

Limitations

Retrospective study design could introduce selection bias.
Study population mainly consisted of Asian patients; results may not be generalizable.
Limited number of patients with LVEF <50% may affect statistical power.
Did not demonstrate serial changes in LVEF.

Implication

May warrant closer SCD surveillance in HCM with reduced LVEF; extends risk models but remains hypothesis-generating.

Abstract

Objective To investigate whether low-normal left ventricular ejection fraction (LVEF) is associated with adverse outcomes in hypertrophic cardiomyopathy (HCM) and evaluate the incremental value of predictive power of LVEF in the conventional HCM sudden cardiac death (SCD)-risk model. Methods This retrospective study included 1858 patients with HCM from two tertiary hospitals between 2008 and 2019. We classified LVEF into three categories: preserved ( ≥ 60%), low normal (50%–60%) and reduced (<50%); there were 1399, 415, and 44 patients with preserved, low-normal, and reduced LVEF, respectively. The primary outcome was a composite of SCD, ventricular tachycardia/fibrillation and appropriate implantable cardioverter-defibrillator shocks. Secondary outcomes were hospitalisation for heart failure (HHF), cardiovascular death and all-cause death. Results During the median follow-up of 4.09 years, the primary outcomes occurred in 1.9%. HHF, cardiovascular death, and all-cause death occurred in 3.3%, 1.9%, and 5.3%, respectively. Reduced LVEF was an independent predictor of SCD/equivalent events (adjusted HR (aHR) 5.214, 95% CI 1.574 to 17.274, p=0.007), adding predictive value to the HCM risk-SCD model (net reclassification improvement 0.625). Compared with patients with HCM with preserved LVEF, those with low-normal and reduced LVEF had a higher risk of HHF (LVEF 50%–60%, aHR 2.457, 95% CI 1.423 to 4.241, p=0.001; LVEF <50%, aHR 7.937, 95% CI 3.315 to 19.002, p<0.001) and cardiovascular death (LVEF 50%–60%, aHR 2.641, 95% CI 1.314 to 5.309, p=0.006; LVEF <50%, aHR 5.405, 95% CI 1.530 to 19.092, p=0.009), whereas there was no significant association with all-cause death. Conclusions Low-normal LVEF was an independent predictor of HHF and cardiovascular death in patients with HCM.

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Cite This Study

Choi et al. (2022) conducted a cohort in Hypertrophic Cardiomyopathy (n=1,858). Reduced LVEF (<50%) was an independent predictor of sudden cardiac death/equivalent events with an adjusted HR of 5.214 compared to preserved LVEF in patients with hypertrophic cardiomyopathy.

synapsesocial.com/papers/6978067976a395df3f7c7e2d https://doi.org/10.1136/heartjnl-2022-321853