| Effect of left ventricular outflow tract obstruction on clinical outcome in hypertrophic cardiomyopathy. | |
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MedLine Citation:
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PMID: 12540642 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The influence of left ventricular outflow tract obstruction on the clinical outcome of hypertrophic cardiomyopathy remains unresolved. METHODS: We assessed the effect of outflow tract obstruction on morbidity and mortality in a large cohort of patients with hypertrophic cardiomyopathy who were followed for a mean (+/-SD) of 6.3+/-6.2 years. RESULTS: Of the 1101 consecutive patients, 273 (25 percent) had obstruction of left ventricular outflow under basal (resting) conditions with a peak instantaneous gradient of at least 30 mm Hg. A total of 127 patients (12 percent) died of hypertrophic cardiomyopathy, and 216 surviving patients (20 percent) had severe, disabling symptoms of progressive heart failure (New York Heart Association [NYHA] functional class III or IV). The overall probability of death related to hypertrophic cardiomyopathy was significantly greater among patients with outflow tract obstruction than among those without obstruction (relative risk, 2.0; P=0.001). The risk of progression to NYHA class III or IV or death specifically from heart failure or stroke was also greater among patients with obstruction (relative risk, 4.4; P<0.001), particularly among patients 40 years of age or older (P<0.001). Age-adjusted multivariate analysis confirmed that outflow tract obstruction was independently associated with an increased risk of both death related to hypertrophic cardiomyopathy (relative risk, 1.6; P=0.02) and progression to NYHA class III or IV or death from heart failure or stroke (relative risk, 2.7; P<0.001). The likelihood of severe symptoms and death related to outflow tract obstruction did not increase as the gradient increased above the threshold of 30 mm Hg. CONCLUSIONS: In patients with hypertrophic cardiomyopathy, left ventricular outflow tract obstruction at rest is a strong, independent predictor of progression to severe symptoms of heart failure and of death. |
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Authors:
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Martin S Maron; Iacopo Olivotto; Sandro Betocchi; Susan A Casey; John R Lesser; Maria A Losi; Franco Cecchi; Barry J Maron |
Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The New England journal of medicine Volume: 348 ISSN: 1533-4406 ISO Abbreviation: N. Engl. J. Med. Publication Date: 2003 Jan |
Date Detail:
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Created Date: 2003-01-23 Completed Date: 2003-01-27 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0255562 Medline TA: N Engl J Med Country: United States |
Other Details:
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Languages: eng Pagination: 295-303 Citation Subset: AIM; IM |
Copyright Information:
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Copyright 2003 Massachusetts Medical Society |
Affiliation:
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Division of Cardiology, Tufts-New England Medical Center, Boston, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Cardiomyopathy, Hypertrophic / complications*, mortality Death, Sudden, Cardiac / etiology Disease Progression Female Heart Failure / classification, etiology*, mortality Humans Male Middle Aged Multivariate Analysis Proportional Hazards Models Prospective Studies Risk Factors Stroke / mortality Ventricular Outflow Obstruction / classification, complications*, ultrasonography |
| Comments/Corrections | |
Comment In:
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N Engl J Med. 2003 May 1;348(18):1815-6; author reply 1815-6
[PMID:
12724493
]
N Engl J Med. 2003 May 1;348(18):1815-6; author reply 1815-6 [PMID: 12728916 ] N Engl J Med. 2003 May 1;348(18):1815-6; author reply 1815-6 [PMID: 12728915 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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