Study Of Clinical Risk Factors In Hypertrophic Obstructive Cardiomyopathy

Part One The prognostic value of uric acid of long-term cardiac death in patients with hypertrophic obstructive cardiomyopathyObjective:This study was aimed to evaluate the prognostic value of uric acid in patients with hypertrophic obstructive cardiomyopathy.Methods:A total of 317 patients with HOCM,who were receiving conservative treatment in Fuwai Hospital from October 2009 to December 2014,all of them completed UA evaluations,were analyzed.Patients were divided into three groups according to UA levels:Tertile 1(?318umol/L,n=106),Tertile 2(319 to 397umol/L,n=105),Tertile 3(>397umol/L,n=106).Results:During a median follow-up of 45 months,29 cardiac deaths(9.1%)occurred,including 6 sudden cardiac deaths and 23 heart failure-related deaths.Cardiac death in Tertile 3(n=16,55.2%)was significantly higher than in Tertile 1(n=6,20.7%)and Tertile 2(n=7,24.1%).In univariate model,UA level(continuous value)showed predictive value of cardiac death[hazard ratio(HR)=1.006,95%CI:1.003-1.009,P=0.009].Univariate Cox survival analysis had shown a significant higher property of cardiac death in patients of Tertile 3 when compared with those of Tertile 1,but cardiac death in patients of Tertile 2 did not show significant prognositic value compared with those of Tertile 1(HR=3.927,95%CI:0.666-23.162,P=0.131).After adjusted putative risk factors as age,body mass index,atrial fibrillation,hemoglobin,creatinine,high-sensitivity C-reactive protein,interventricular septum/left ventricular posterior wall ratio,left ventricular outflow tract and left ventricular ejection fraction into the multiple Cox regression analysis,UA was still an independent risk factor(HR=1.005,95%CI:1.001-1.009,P=0.009)of long-term cardiac death in patients with HOCM.Kaplan-Meier survival analysis were performed in male(n=187)and female(n=130)sub-groups.Significant difference of cardiac death was found in female sub-group(P=0.011)butnotinmale(P=0.251).Conclusions:UA concentration was found to be independently associated with cardiac death in HOCM patients receiving conservative treatment.The prognostic impact of UA to HOCM may have a gender difference.Part two Hemoglobin and Anemia are independent risk factors of Cardiac Mortality in Patients with Hypertrophic Obstru-ctive CardiomyopathyObjective:To evaluate the predictive value of hemoglobin and anemia in long-term cardiac mortality for patients with hypertrophic obstructive cardiomyopathy(HOCM).Methods:A total of 325 patients with HOCM,who were receiving conservative treatment in Fuwai Hospital from October 2009 to December 2014,all of them completed hemoglobin evaluations,were analyzed.Results:During a median follow-up of 43.55 months,29 cardiac deaths(8.9%)were observed.Univariate Cox regression analysis determined the hemoglobin to be a risk factor of cardiac death in HOCM(HR=0.61,95%CI 0.943-0.979;,P<0.001).Hemoglobin(HR=0.960,95%CI 0.929-0.991;P=0.011)andanemia(HR=4.118,95%CI 1.114-14.822;P=0.030)were both found to be independently associated with cardiac death in multiple Cox regression analysis model after adjusted for age,BMI,creatinine,hs-CRP,NT-proBNP,LOVTG at rest,left ventricular ejection fraction,left ventricular end-diastolic diameter and atrial fibrillation.Kaplan-Meier survival analysis showed a significant higher cardiac mortality in patients with anemia when compared with patients without anemia.Conclusions:Hemoglobin concentration and anemia was determined to be independent risk factors of cardiac death in patients with hypertrophic obstructive cardiomyopathy.Patients with HOCM comorbid with anemia have a much higher cardiac mortality.Part Three The Age,Creatinine Clearance and Ejection Fraction(mACEF)Score Predicts Long-term Mortality of Patients with Hypertrophic Obstructive CardiomyopathyObjective:The age,ejection fraction and renal function are the risk factors in the development of hypertrophic obstructive cardiomyopathy(HOCM).The objective of the present study was to evaluate the prognostic value of a simple composite risk score which contains only age,ejection fraction and renal function in predicting long-term outcome in patients with HOCM.Methods:In total,924 HOCM adult patients with intact medical record to calculate the Age,Creatinine Clearance and Ejection Fraction(mACEF)score was enrolled in this study.The primary endpoints were all-cause death and cardiac death.The area under the receiver operating characteristic(AUROC),Kaplan-Meier plot and Cox survival analysis were performed for determining the prognostic value of mACEF.Results:After a median follow-up of 39 months,46 all-cause deaths and 40 cardiac deaths were observed.The mACEF score was found to be effective in predicting long-term all-cause mortality(AUROC=80.0%)and cardiac mortality(AUROC=81.2%)in patients with HOCM.The optimum cutoff value of the mACEF score in all-cause mortality and cardiac mortality was 0.955 and 0.960.After adjusted for putative risk factors,the mACEF remains an independent risk factor of all-cause death(HR,1.228;95%CI,1.025-1.618)and cardiac death(HR,1.303;95%CI,1.038-1.636).Patients were divided into high-risk group(mACEF?0.960)and low-risk group(mACEF<0.960)according to the mACEF levels.Multiple Cox survival analysis confirmed that patients in the high-risk were at significantly higher risk of all-cause death(HR=5.571,95%CI 2.601?11.93;P<0.001)and cardiac death(HR=7.750,95%CI 3.263?18.403;P<0.001).Sub-group survival analysis was performed inlow-risk and high-risk groups respectively.Invasive treatment was found significantly reduced all-cause mortality and cardiac mortality in high-risk sub-group but not low-risk sub-group.Conclusions:The mACEF score is an effective tool for risk stratification in HOCM patients.The benefits of invasive treatment may be greater in patients with m ACEF>0.96.