Key result
Right ventricular function assessed by TAPSE (HR 0.24; 95% CI 0.06-0.93) or RV free wall strain (HR 1.12; 95% CI 1.03-1.21) independently predicted adverse cardiac events in patients with HCM.
Why the study?
Patients with hypertrophic cardiomyopathy have heterogeneous outcomes, and risk stratification mostly focuses on left-side myocardial function.
Does right ventricular function assessment (TAPSE and RV free wall strain) predict adverse cardiovascular events in patients with hypertrophic cardiomyopathy?
Cohort (n=56)
Does right ventricular function assessment (TAPSE and RV free wall strain) predict adverse cardiovascular events in patients with hypertrophic cardiomyopathy?
Hazard Ratio: 0.24 (95% CI 0.06–0.93)
Right ventricular function parameters, specifically TAPSE and RV free wall strain, provide independent and incremental prognostic value beyond left ventricular function for predicting adverse events in patients with hypertrophic cardiomyopathy.
RV metrics may refine HCM risk stratification beyond LVEF; hypothesis-generating, should not yet change practice.
BACKGROUND: Patients with hypertrophic cardiomyopathy (HCM) have heterogeneous outcomes. As risk stratification mostly focuses on left-side myocardial function, we sought to investigate the prognostic value of right ventricular (RV) function in patients with HCM. METHODS: This retrospective cohort study included patients with HCM. Conventional ventricular functional parameters, including left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE), and fractional area change were obtained. The longitudinal strain was analyzed using the speckle tracking method. The primary endpoint was defined as a composite of hospitalization for heart failure, sustained ventricular tachycardia, or all-cause death. RESULTS: A total of 56 patients with HCM (aged 58.0 ± 14.9 years, 64.3% male) were included. After a mean follow-up duration of 30.1 ± 17.4 months, primary endpoints developed in 10 (20%) of 50 patients who were treated medically. Patients with cardiovascular events had a more reduced LV thickest segmental strain, worse TAPSE, and more impaired RV free wall strain. After adjusting for age, sex, and LVEF, TAPSE (hazard ratio [HR], 95% confidence intervals [CIs]: 0.24, 0.06-0.93) and RV free wall strain (HR, 95% CIs:1.12, 1.03-1.21) remained independent prognostic predictors. Incorporating either TAPSE or RV free wall strain provides incremental prognostic value to the LV strain alone (net reclassification improvement by 31.4% and 34.1%, respectively, both p < 0.05). CONCLUSION: RV function assessed by TAPSE or RV free wall strain is predictive of subsequent cardiac events, suggesting that a comprehensive evaluation of RV function is useful for risk stratification in patients with HCM.
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Chang et al. (2022) conducted a cohort in Hypertrophic cardiomyopathy (n=56). Right ventricular function (TAPSE or RV free wall strain) was evaluated on Composite of hospitalization for heart failure, sustained ventricular tachycardia, or all-cause death (HR 0.24, 95% CI 0.06-0.93). Right ventricular function assessed by TAPSE (HR 0.24; 95% CI 0.06-0.93) or RV free wall strain (HR 1.12; 95% CI 1.03-1.21) independently predicted adverse cardiac events in patients with HCM.
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