Clinical Study On Prognostic Evaluation Of Patients With Hypertrophic Cardiomyopathy

Background and aim:A novel risk prediction model(HCM Risk-SCD)which estimates the 5-year risk of sudden cardiac death(SCD)of patients with hypertrophic cardiomyopathy(HCM)has been recommended by 2014 European Society of Cardiology(ESC)guidelines of HCM.However,this new risk stratification method has not been validated in Chinese patients with HCM.This study was aimed to conduct a validation study of the HCM Risk-SCD model to identify patients at high risk of SCD in Chinese patients with HCM.Methods:This observational and retrospective study included 1216 Chinese patients with HCM.A composite of SCD and equivalent events was defined as primary endpoint.Receiver operating characteristic curves and C-statistics were calculated for the HCM Risk-SCD model.Cox regression analysis was performed in order to identify predictors of endpoint event.Results:A total of 1125 patients(mean age 46.20±14.47 years,33.2%of women)completed the follow-up.During the average follow-up period of 5.89±3.73 years,fifty-nine patients reached primary endpoint.The C-statistics for the use of the HCM Risk-SCD model was 0.607(95%Confidence interval,0.539-0.675,P=0.006).Cox regression analysis revealed that estimated 5-year SCD risk?4%was a significant predictor for primary endpoint event.Conclusion:HCM Risk-SCD model is reliable in SCD prediction in Chinese patients with HCMBackground and aim:Maximal left ventricular wall thickness(MLVWT)?30mm is a predictor of sudden cardiac death(SCD)in patients with hypertrophic cardiomyopathy(HCM).However,the relationship between MLVWT and sudden cardiac death events in HCM patients with extreme left ventricular hypertrophy remains unclear.The 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy recommended the use of HCM Risk-SCD model in the SCD risk stratification of patients with HCM,however,it is not clear whether this model is suitable for HCM patients with extreme left ventricular hypertrophy.This study was aimed to solve these problems and to identify risk factors for SCD events in HCM patients with extreme left ventricular hypertrophy.Methods:This observational and retrospective cohort study included 342 HCM patients with extreme left ventricular hypertrophy.A composite of SCD and equivalent events was defined as primary endpoint.Cox regression analysis was performed in order to identify predictors of endpoint event.Results:A total of 328 patients completed the follow-up.During the average follow-up period of 6.3±3.8 years,twenty-eight patients reached primary endpoint.The actual five-year SCD incidence of patients enrolled in the study was 6.78%,and the estimated five-year SCD incidence based on the HCM Risk-SCD model was 3.99±2.88%.The C statistic for the use of HCM Risk-SCD model was 0.61(95%CI,0.49-0.72,P=0.052)in HCM patients with extreme left ventricular hypertrophy.Cox regression analysis revealed that maximal left ventricular wall thickness was not a predictor for primary endpoint event(HR 1.03,95%Confidence interval 0.94-1.14,P=0.53)in patients included in this study.However,non-sustained ventricular tachycardia(NSVT)has been proved to be a risk factor of primary endpoint event in HCM patients with extreme left ventricular hypertrophy.Conclusion:There is no liner relationship between maximal left ventricular wall thickness and SCD risk in HCM patients with extreme left ventricular hypertrophy.HCM Risk-SCD model may not be suitable for HCM patients with extreme left ventricular hypertrophy.Non-sustained ventricular tachycardia may be a risk factor of SCD events in this group.Background and aim:The relationship between gender and the prognosis of hypertrophic cardiomyopathy remains unclear.In recently years,some studies have shown that female gender may associated with poor prognosis in patients with hypertrophic cardiomyopathy.However,the number of these studies was small,and most of them were single-center study.Furthermore,none of these studies included patients with hypertrophic cardiomyopathy from China.Our study was aimed to investigate the relationship between gender and survival prognosis in patients with hypertrophic cardiomyopathy from China and identify the risk factors of all-cause death in patients with hypertrophic cardiomyopathy.Methods:This observational,retrospective study included 1216 Chinese patients with hypertrophic cardiomyopathy.All-cause death was defined as primary endpoint.Cox regression analysis was performed in order to identify predictors of endpoint events.Results:A total of 1125(mean age 46.20±14.47 years,33.2%female)patients completed the follow-up.During the average follow-up period of 5.89±3.73 years,seventy-eight patients reached primary endpoint.At baseline,women were older,had more symptoms and higher left ventricular outflow tract gradient compared with men.Cox regression revealed that female gender(hazard ratio 1.757,95%confidence interval 1.116-2.765,P=0.015),atrial fibrillation(hazard ratio 2.010,95%confidence interval 1.167-3.461,P=0.012),baseline NYHA functional classes III/IV(hazard ratio 1.835,95%Confidence interval 1.159-2.906,P=0.010),and decreased left ventricular ejection fraction(hazard ratio,0.969,95%confidence interval 0.946-0.993,P=0.011)were independently associated with mortality.Kaplan-Meier analysis demonstrated higher mortality in women compared with men(P=0.002).Conclusion:Female gender may be associated with poor survival prognosis in patients with hypertrophic cardiomyopathy.