Author + information
- Xiying Guo,
- Chaomei Fan,
- Yinjian Yang,
- Shuoyan An,
- Shanshan Zhai,
- Fujian Duan,
- Fei Hang and
- Yishi Li
Background: The abnormal hemodynamic caused by obstruction is common among patients with hypertrophic cardiomyopathy (HCM) and correlates with their prognoses. This study was designed to investigate the differences among HCM patients with different ventricular obstruction locations.
Methods: A total of 2,068 patients with HCM were enrolled from 1994 to 2011 in Fuwai Hospital. Left ventricular outflow tract (LVOT) obstruction or midventricular obstruction (MVO) was defined as the condition when pressure gradient ≥ 30 mmHg of LVOT or midventricle. If the gradient ≥ 25 mmHg of right ventricular outflow tract (RVOT), a RVOT obstruction could be considered. Patients were divided into 4 groups according to their obstruction locations. The clinical features and outcomes of the 4 groups were compared. The Kaplan-Meier and log-rank test were used for survival estimates.
Results: 17 patients (0.8%) with isolated RVOT obstruction, 720 patients (34.8%) with isolated LVOT obstruction, 21 patients (1.0%) with biventricular tracts (BVOT) obstruction, and 65 patients with MVO (3.1%) were finally enrolled. Patients with isolated RVOT obstruction were the youngest (32±17 years old) and had the highest female proportion (71%, p < 0.001), and palpitation was mostly frequent detected in these patients (64%, p < 0.001). New York Heart Association function class III/IVat baseline was detected more often in MVO group (49%, p < 0.001). After 7 years of follow-up, MVO group showed the highest cardiovascular mortality (13%, p <0.001), and the same rate of LVOT obstruction group was 8%. No patient died in either isolated RVOT or BVOT obstruction group during follow-up. The cardiovascular morbidity did not show statistic difference among 4 groups (p = 0.38). Non-sustained ventricular tachycardia was detected mostly in MVO group (28.8%, p < 0.0001), and syncope was most frequent in LVOT obstruction group (43.1%, p = 0.0003). There were no significant difference of atrial fibrillation, embolic stroke or heart failure among 4 groups.
Conclusions: Although patients with isolated RVOT or BVOT obstruction are quite rare, their outcomes are relatively benign. Patients with MVO shows low incidence but worse prognosis in HCM.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Advances in HCM, PPCM and Other Cardiomyopathies
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1201-276
- 2017 American College of Cardiology Foundation