| Objective:Hypertrophic obstructive cardiomyopathy(HOCM)is a common cardiac disorder in clinical practice,which has already been recognized as the most common cause of cardiogenic sudden death in adolescents.B-type natriuretic peptide(BNP)has shown great association with left ventricular hypertrophy and hypertrophic cardiomyopathy in previous studies,but the value of plasma BNP level in assessing the disease progression of hypertrophic obstructive myopathy(HOCM)is still remain undiscovered.As septal myectomy is a practical therapy in treating severe patients with HOCM,the need of a reliable risk stratification strategy for the surgical outcomes becomes an urgent agenda,whether serum BNP can play an important role in it still needs evidence.Methods:One hundred and seven hospitalized patients from October 2013 to October 2015,with the diagnosis of HOCM,were enrolled in this study.All patients received septal myectomy.Pearson correlation coefficient and Spearman correlation coefficient were used to analysis the relationship between serum BNP level and the symptoms of the patient,the maximum septum thickness and the left ventricular outflow tract pressure gradient level.A Cox proportional hazards model was used to identify the risk factors of composite end-points.A stepwise multivariable Cox proportional hazards model was developed to determine the independent risk factors.The proportional hazards assumption in the Cox model was assessed with models including time-by-covariate interactions.Cumulative event rates were calculated using a Kaplan-Meier method,and different event curves of outcomes were compared using a Log-Rank or Tarone-Ware test.Results:The serum BNP level before surgery was not related to neither the symptoms of the patient,nor the maximum septum thickness or the left ventricular outflow tract pressure gradient level before surgery.16 adverse outcomes were observed during the 18-month follow-up,including 1 sudden death,1 re-hospitalization,4 heart failures,1 stroke,and 4 left ventricular outflow tract pressure gradient over 30 mmHg.We separated the patients into two groups according to the serum BNP levels.There were no differences in the baseline clinical characteristics between the two groups,except for the left atrial diameter and LVOT pressure gradient.There's no difference in the three-month,one-year,and 18-month composite end-point event-free survival rates between the two groups(Log-Rank p=0.734;Breslow p=0.683).In the Cox proportional hazard models for the composite end-points,we included all patients in the analysis.Variables with P<0.05 were then entered into a stepwise multivariable analysis.Old age and postoperative AF were identified as independent predictors of worse outcomes in HOCM patients undergoing surgical treatment.Conclusions:The serum BNP level before surgery was not related to neither the symptoms of the patient,nor the maximum septum thickness or the left ventricular outflow tract pressure gradient level.High level of serum BNP before surgery could not predict the prognosis.On the other hand,old age and postoperative AF were identified as independent predictors of worse outcomes in HOCM patients undergoing surgical treatment.Objective:Growth Differentiation Factor 15(GDF-15)was proved to be related to myocardial protection and anti-hypertrophic cardiomyopathy effect.As septal myectomy is a practical therapy in treating severe patients with HOCM,the need of a reliable risk stratification strategy for the surgical outcomes becomes an urgent agenda.We aimed at finding out whether serum GDF-15 level can play an important role in risk assessment and prognosis prediction for patients with HOCM who need surgical treatment.Methods:Eighty six hospitalized patients from October 2013 to March 2015,with the diagnosis of HOCM,were enrolled in this study.All patients received septal myectomy.Pearson correlation coefficient and Spearman correlation coefficient were used to analysis the relationship between serum GDF-15 level and the symptoms of the patient,the maximum septum thickness and the left ventricular outflow tract pressure gradient level.A Cox proportional hazards model was used to identify the risk factors of composite end-points.A stepwise multivariable Cox proportional hazards model was developed to determine the independent risk factors.The proportional hazards assumption in the Cox model was assessed with models including time-by-covariate interactions.Cumulative event rates were calculated using a Kaplan-Meier method,and different event curves of outcomes were compared using a Log-Rank or Tarone-Ware test.Results:The serum GDF-15 level before surgery was proved to be related to the left ventricular outflow tract pressure gradient level before surgery.11 adverse outcomes were observed during the 24-month follow-up,including 1 sudden death,1 re-hospitalization,2 heart failures and 3 left ventricular outflow tract pressure gradient over 30 mmHg.We found a critical value of serum GDF-15 level,which is 467.48 ng/L,and separated the patients into two groups according to the serum GDF-15 level.There were no differences in the baseline clinical characteristics between the two groups,except for the left atrial diameter and LVOT pressure gradient.There' s a statistical difference in the three-month,one-year,and 24-month composite end-point event-free survival rates between the two groups(Log-Rank p=0.023;Breslow p=0.041).In the Cox proportional hazard models for the composite end-points,we included all patients in the analysis.Variables with P<0.05 were then entered into a stepwise multivariable analysis.Old age,postoperative AF and serum GDF-15 level before surgery were identified as independent predictors of worse outcomes in HOCM patients undergoing surgical treatment.Conclusions:The serum GDF-15 level before surgery was related to the left ventricular outflow tract pressure gradient level.Old age,postoperative AF and high level of serum GDF-15 before surgery were identified as independent predictors of worse outcomes in HOCM patients undergoing surgical treatment.Objective:Tenascin-C(TN-C)was proved to be related to myocardial injury and myocardial fibrosis.As septal myectomy is a practical therapy in treating severe patients with HOCM,the need of a reliable risk stratification strategy for the surgical outcomes becomes an urgent agenda.We aimed at finding out whether serum TN-C level can play an important role in risk assessment and prognosis prediction for patients with HOCM who need surgical treatment.Methods:Eighty six hospitalized patients from October 2013 to March 2015,with the diagnosis of HOCM,were enrolled in this study.All patients received septal myectomy.Pearson correlation coefficient and Spearman correlation coefficient were used to analysis the relationship between serum TN-C level and the symptoms of the patient,the maximum septum thickness and the left ventricular outflow tract pressure gradient level.A Cox proportional hazards model was used to identify the risk factors of composite end-points.A stepwise multivariable Cox proportional hazards model was developed to determine the independent risk factors.The proportional hazards assumption in the Cox model was assessed with models including time-by-covariate interactions.Cumulative event rates were calculated using a Kaplan-Meier method,and different event curves of outcomes were compared using a Log-Rank or Tarone-Ware test.Results:The serum TN-C level before surgery was proved to be related to the left ventricular outflow tract pressure gradient level and the maximum septum thickness before surgery.11 adverse outcomes were observed during the 24-month follow-up,including 1 sudden death,1 re-hospitalization,2 heart failures and 3 left ventricular outflow tract pressure gradient over 30 mmHg.We found a critical value of serum TN-C level,which is 7.24 ?g/mL(AUC=0.567,p<0.05),through the ROC curve,and separated the patients into two groups according to the serum TN-C level.There were no differences in the baseline clinical characteristics between the two groups,except for the maximum septum thickness and LVOT pressure gradient.There's a statistical difference in the three-month,one-year,and 24-month composite end-point event-free survival rates between the two groups(Log-Rank p=0.023;Breslow p=0.041).But we could not find the difference after we adjust the curve with the maximum septum thickness and LVOT pressure gradient(HR=0.694[0.343,1.726],p=0.465).Conclusions:The serum TN-C level before surgery was related to the left ventricular outflow tract pressure gradient level and the maximum septum thickness.High level of serum TN-C(>7.24 ?g/mL)before surgery were identified as a predictors of worse outcomes in HOCM patients undergoing surgical treatment,but it is not an independent predictor. |
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