In HCM patients, impaired CFVR in LAD (≤2) independently predicted a 12-fold higher risk of cardiac death or heart failure over 9 years.
Does impaired coronary flow velocity reserve (CFVR ≤2) predict cardiac death and heart failure hospitalization in patients with hypertrophic cardiomyopathy?
In patients with hypertrophic cardiomyopathy, impaired coronary flow velocity reserve (≤2) is a strong independent predictor of long-term cardiac mortality and heart failure hospitalization.
Absolute Event Rate: 0% vs 0%
Abstract Background Microvascular dysfunction might be a major determinant of clinical deterioration and outcome in patients with hypertrophic cardiomyopathy (HCM). However, long-term prognostic value of transthoracic Doppler echocardiography (TDE) coronary flow velocity reserve (CFVR) on cardiac mortality and heart failure requiring hospitalization is uncertain in HCM patients. Objective The aim of our study was to assess long-term prognostic value of CFVR on clinical outcome in HCM population. Methods In a single center, prospective, observational study, we enrolled 196 HCM patients (100 women; mean age 48±14 years) free of coronary artery disease. CFVR in left anterior descending (LAD) coronary artery was assessed in all patients with adenosine (0.14 mg/kg/min, intravenously, during 2 minutes). The primary outcome was a composite of cardiac death and heart failure requiring hospitalization. Results Patients were stratified into two subgroups depending on CFVR LAD value: Group 1 (CFVR 2, n=119) and Group 2 (CFVR ≤2, n=77). During a median follow-up of 109 months, 40/196 (20.4%) patients had events. In Group 1, there were 4/119 (2.0%), whereas in Group 2 there were 36/77 (46.7%, p0.001 vs. Group 1) events. By Kaplan-Meier analysis, Group 1 patients had significantly higher cumulative event-free survival rate compared to Group 2 (98.3% and 97.0% vs. 75.2% and 55.3% at 5 and 8 years, respectively: log-rank 51.1, p0.001), Figure 1. Multivariable analysis identified only CFVR ≤2 as an independent predictor for adverse cardiac outcome (HR 12.150; 95% CI 4.192-35.213, p0.001), adjusted for the age, gender, family history of sudden cardiac death, maximal wall thickness, presence of at least moderate mitral regurgitation and left atrial volume index 34ml/m2. Conclusion In patients with HCM free of coronary artery disease, impaired CFVR in LAD (≤2) is a strong, independent long term predictor of adverse cardiac outcome.
Tesic et al. (Sat,) reported a other. In HCM patients, impaired CFVR in LAD (≤2) independently predicted a 12-fold higher risk of cardiac death or heart failure over 9 years.