Clinical Prognosis Of Patients With Hypertrophic Obstructive Cardiomyopathy After Ventricular Septal Resectio

BackgroundObesity is an established cardiovascular risk factor in hypertrophic cardiomyopathy（HCM）patients.Postoperative atrial fibrillation（POAF）is one of the most common complications after surgery in patients with obstructive HCM（OHCM）.We aimed to determine the impact of body mass index（BMI）on the occurrence of POAF in patients with OHCM who underwent septal myectomy.Methods and ResultsIn all,712 OHCM patients without previous atrial fibrillation who underwent septal myectomy were identified.Patients were stratified into 3 groups based on BMI.Of these,224（31.5%）had normal weight（BMI<24 kg/m2）,339（47.6%）were overweight（BMI 24 to<28 kg/m2）,and 149（20.9%）were obese（BMI≥28 kg/m2）.Overweight and obese patients had increased levels of left atrial diameter（LAD）（P<0.001）and left ventricular end-diastolic diameter（P<0.001）,compared with patients with normal weight.Among 184 patients（25.8%）developing POAF,32 cases（14.3%）occurred in the normal weight group,100 cases（29.5%）occurred in the overweight group,and 52 cases（34.9%）occurred in the obese group（P<0.001）.Logistic regression analysis indicated that overweight（odds ratio[OR]:2.161,95%confidence interval[CI]:1.333-3.503,P=0.002）or obesity（OR:2.803,95%CI:1.589-4.944,P<0.001）,age（OR:1.037,95%CI:1.018-1.057,P<0.001）,and LAD（OR:1.060,95%CI:1.027-1.095,P<0.001）were independently associated with the occurrence of POAF in patients with OHCM.ConclusionsOverweight and obesity are strong predictors of POAF in patients with OHCM.Strategies aimed at lowering BMI may be a potential way to prevent POAF.BackgroundAcute kidney injury（AKI）is one of the most common complications after cardiac surgery.However,AKI is less studied in patients with hypertrophic cardiomyopathy（HCM）.Previous studies suggest that inflammation may play an important role in the pathogenesis of AKI.This study was conducted to investigate the occurrence of AKI of obstructive hypertrophic cardiomyopathy（OHCM）patients and the relation between cytokines levels and the AKI after septal myectomy.Methods and ResultsA total of 217 OHCM patients who underwent septal myectomy were enrolled.The levels of cytoWnes（interieukin（IL）-ip、IL-2、EL₄、EL-5、IL-6、IL-8、IL-10、IL₁2p70、IL-17、tumor necrosis factor-ou interferon-a、interferon-y and high sensitivity C-reactive protein）were measured in all patients.Patients were stratified into 2 groups based on the occurrence of AKI: AKI group（n=20? 9.2%）and non-AKI（n=197? 92.8%）.Compared with patients in the non-AKI group,patients in AKI group were older（P=0.007）s more likely to have hypertension（P=0.003）? atrial fibrillation（P=0.002）s and higher levels of NT-proBNP（i^O.036）.Besides,the levels of IL-5（3.81（4.14-1.94）pg/ml vs.1.78（4.00-1.49）pg/ml,P=0.021）,IL-6（6.51（11.04-4.96）pg/ml vs.5.52（7.82-3.70）pg/ml,P=0.041）,IL-10（4.93（5.93-2.97）pg/ml vs.3.66（5.05-2.39）pg/ml? P=0.046）5 and IL-12p70（4.77（5.89-4.02）pg/ml vs.3.85（5.20-2.33）pg/ml5 P=0.017）were higher in patients with AKI than patients without AKI.Logistic regression analysis showed that the levels of IL-10（odds ratio（OR）=1.173,95% confidence interval（Cl）: 1.051-1.310,P=0.005）,hypertension history（OR=5.093,95%CI: 1₇15-15.129,P=0.003）and cardiopulmonary bypass time（OR =1.007,95%CI: 1.000-1.014,P=0.047）were independent predictors of AKI in patients with OHCM who underwent septal myectomy.And the occurrence of AKI in the third tertile of IL-10 levels was 4 times that of patients in the first tertile（OR^.327,95%CI:L211-15.456,P=0.024）ConclusionsThe occurrence of AKI after septal myectomy in OHCM patients were 9.2%.The preoperative EL,-10 level is the independent predictors of AKI in patients with OHCMs and the potential mechanism needs to be further studied.Strategies aimed at closely monitoring the renal function in OHCM patients with higher IL-10 levels and timely treatment could help avoid the occurrence of AKI.BackgroundHypertrophic cardiomyopathy（HCM）is an autosomal dominant monogenic cardiomyopathy.Disease-causing genetic mutations can be detected in nearly half of HCM patients,the most common mutated genes being MYH7 and MYBPC3.Previous studies have reported that patients with sarcomere mutation have a poor prognosis.However,it is unclear whether there are differences in the impact of different genotypes on the clinical prognosis of HCM patients.This study aimed to explore the clinical prognosis of OHCM patients with MYH7 mutation or MYBPC3 mutation or genotype negative,and determined if there is a difference.Methods and ResultsA total of 380 patients with OHCM who underwent septal myectomy and completed genetic testing were enrolled.Base on the genetic testing results,patients were divided into 3 groups: the MYH7 mutation group（n=91）,the MYBPC3 mutation group（n=74）5and the genotype negative group（n=215）.Patients were followed regularly after surgery to record their survival status and adverse events.The primary endpoints were composite adverse events of cardiovascular death（sudden cardiac death,myocardial infarction deatih）,heart failure requiring hospitalization,new-onset atrial fibrillation and stroke.With a median follow-up of 35.12 months（interquartile range: 50.61-24.78 months）,a total of 34 patients（9.9%）had primary endpoint events.The 3-year survival rate without the primary endpoints of the enrolled patients were 94.0%±1.3%.Kaplan-Meier survival analysis showed that there was no significant difference in the primmy endpoint event-free survival rate（95.0%±2.0%vs.93.0%±3.0%vs.93.0%±2.0%? Log rank/M）.888)_However,the occurrence of sudden cardiac death was 4₄% in patients with MYH7 mutation,1.4% in patients with MYBPC3 mutation,and only 0.5% in patients with negative genotype.Kaplan-Meier survival analysis showed that there was a significant difference in the occurrence of sudden cardiac death among the three groupsof patients（Overall Log rank P=0.029）? and the sudden cardiac death event-free survival rate of patients with MYH7 mutation was significantly lower than that of patients with genotype negative group（Log rank P=0.009）.There was no significant difference between the MYH7 mutation group and MYBPC3 mutation group（Log rank P=0.309）.And there was no significant difference between the MYBPC3 mutation group and genotype negative group（Log rank P=0.095）.Multivariate Cox regression analysis showed that MYH7 mutation was an independent predictor for sudden cardiac death in patients with OHCM（hazard ration=14.568,95% confidence interval: 1,059-200.429,P=0.045）.ConclusionsThere was a significant difference in the occurrence of sudden cardiac death among patients with MYH7 mutation or MYBPC3 mutation or genotype-negative.MYH7 mutation is an independent risk factor of sudden cardiac death in OHCM patients.Genetic testing and the identification of gene mutation may play an important role in the risk stratification and management of OHCM patients.