| The prognostic importance of left ventricular outflow obstruction in hypertrophic cardiomyopathy varies in relation to the severity of symptoms. | |
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MedLine Citation:
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PMID: 15808767 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: The aim of this study was to investigate whether the prognostic importance of left ventricular (LV) outflow obstruction in hypertrophic cardiomyopathy (HCM) is influenced by other predictors of morbidity and mortality. BACKGROUND: It remains unknown whether the effect of outflow obstruction on clinical outcome in HCM is influenced by other determinants of survival. METHODS: We assessed the impact of severity of symptoms, LV wall thickness, atrial fibrillation, and age on the prognostic importance of outflow obstruction in a large HCM population. RESULTS: Of 526 consecutive HCM patients, 141 (27%) had outflow obstruction. During a follow-up of 4.5 +/- 4.1 years, 34 patients died of HCM. The incidence of cardiovascular death was significantly higher among patients with LV obstruction than among those without obstruction (relative risk [RR] = 2.14; p = 0.02). The prognostic power of the outflow gradient changed in relation to severity of symptoms (p = 0.024). At initial evaluation, LV obstruction was a significant predictor of cardiovascular mortality only in New York Heart Association (NYHA) functional class I to II patients (hazard ratio [HR] = 2.38; p = 0.025). During follow-up, at time of development of severe symptoms, the outflow gradient lost its prognostic significance (HR = 1.18; p = 0.66), whereas NYHA functional class III to IV was associated with an eight-fold increase in risk of cardiovascular mortality (HR = 7.90; p < 0.001). CONCLUSIONS: In patients with HCM, the prognostic importance of LV outflow obstruction varies in relation to the severity of symptoms. In patients with mild or no symptoms, obstruction is an important predictor of cardiovascular death. After development of severe symptoms, NYHA functional class becomes the dominant marker of prognosis independently of the presence of an outflow gradient. |
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Authors:
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Camillo Autore; Paola Bernabò; Caterina Stella Barillà; Paolo Bruzzi; Paolo Spirito |
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Publication Detail:
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Type: Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 45 ISSN: 0735-1097 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 2005 Apr |
Date Detail:
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Created Date: 2005-04-05 Completed Date: 2005-04-22 Revised Date: 2012-02-22 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 1076-80 Citation Subset: AIM; IM |
Affiliation:
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Divisione di Cardiologia, Università di Roma La Sapienza, Ospedale Sant'Andrea, Via Grottarossa 1035-1039, 00189 Rome, Italy. camillo.autore@uniroma1.it |
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| MeSH Terms | |
Descriptor/Qualifier:
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Cardiomyopathy, Hypertrophic
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complications,
mortality*,
pathology,
ultrasonography Female Humans Italy / epidemiology Male Middle Aged Predictive Value of Tests Proportional Hazards Models Severity of Illness Index* Survival Analysis Ventricular Outflow Obstruction / complications, mortality*, pathology, ultrasonography |
| Grant Support | |
ID/Acronym/Agency:
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0860C//Telethon |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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