Adverse left ventricular remodeling, including an increase in NYHA class (OR 8.7; 95% CI 2.5-30.5; P=0.001), significantly increased sudden cardiac death risk in hypertrophic cardiomyopathy.
Case-Control (n=164)
Does adverse left ventricular remodeling increase the risk of sudden cardiac death in patients with hypertrophic cardiomyopathy?
Adverse left ventricular remodeling, indicated by worsening NYHA class and declining systolic or diastolic function, significantly increases the risk of sudden cardiac death in patients with hypertrophic cardiomyopathy.
Odds Ratio: 8.7 (95% CI 2.5–30.5)
p-value: p=0.001
BACKGROUND: Adverse left ventricular (LV) remodeling predicts heart failure symptoms and overt LV dysfunction in patients with hypertrophic cardiomyopathy (HCM), but its influence on the occurrence of sudden cardiac death (SCD) is unknown. The aim of this study was to investigate the effect of adverse LV remodeling on SCD risk in patients with HCM. HYPOTHESIS: Adverse LV remodeling increases SCD in HCM patients. METHODS: This study included 41 patients with HCM who experienced SCD; each case was matched with 3 controls based on age, gender, and time of first contact. In this population of 164 patients, predictors of SCD were identified using univariable and multivariable logistic regression and expressed as odds ratio (OR) with 95% confidence interval (CI). RESULTS: Baseline characteristics, such as New York Heart Association (NYHA) class, systolic and diastolic left ventricular function, left ventricular wall thickness, left atrial size, atrial fibrillation, and established risk factors for SCD were similar in cases and controls. Independent predictors of SCD during follow-up (median follow-up, 7.7 ± 6.5 years) were: increase in NYHA class (OR: 8.7 95% CI: 2.5-30.5, P = 0.001), decrease of fractional shortening (per % decrease, OR: 1.09 95% CI: 1.03-1.14, P = 0.001), and decrease of diastolic function (OR: 3.5 95% CI: 1.2-10.2, P = 0.02). CONCLUSIONS: This study shows that SCD risk in HCM increases when adverse remodeling occurs. Because cases and controls were similar at baseline, these findings emphasize the importance of vigilant follow-up of HCM patients and could aid clinical decision making concerning implantable cardioverter-defibrillator implantation, especially in patients with moderate risk for SCD.
Vriesendorp et al. (2014) conducted a case-control in Hypertrophic Cardiomyopathy (n=164). Adverse left ventricular remodeling vs. No adverse left ventricular remodeling was evaluated on Sudden cardiac death (OR 8.7, 95% CI 2.5-30.5, p=0.001). Adverse left ventricular remodeling, including an increase in NYHA class (OR 8.7; 95% CI 2.5-30.5; P=0.001), significantly increased sudden cardiac death risk in hypertrophic cardiomyopathy.
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