Document Detail

Effect of left ventricular outflow tract obstruction on clinical outcome in hypertrophic cardiomyopathy.
MedLine Citation:
PMID:  12540642     Owner:  NLM     Status:  MEDLINE    
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.
Martin S Maron; Iacopo Olivotto; Sandro Betocchi; Susan A Casey; John R Lesser; Maria A Losi; Franco Cecchi; Barry J Maron
Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The New England journal of medicine     Volume:  348     ISSN:  1533-4406     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  2003 Jan 
Date Detail:
Created Date:  2003-01-23     Completed Date:  2003-01-27     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  295-303     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2003 Massachusetts Medical Society
Division of Cardiology, Tufts-New England Medical Center, Boston, USA.
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MeSH Terms
Cardiomyopathy, Hypertrophic / complications*,  mortality
Death, Sudden, Cardiac / etiology
Disease Progression
Heart Failure / classification,  etiology*,  mortality
Middle Aged
Multivariate Analysis
Proportional Hazards Models
Prospective Studies
Risk Factors
Stroke / mortality
Ventricular Outflow Obstruction / classification,  complications*,  ultrasonography
Comment In:
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 ]

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