Prevalence, causes and predictors of cardiovascular hospitalization in patients with hypertrophic cardiomyopathy

Ciabatti, Michele; Fumagalli, Carlo; Beltrami, Matteo; Vignini, Elisa; Martinese, Lucia; Tomberli, Alessia; Zampieri, Mattia; Bertini, Alenya; Carrassa, Gianmarco; Marchi, Alberto; Berteotti, Martina; Cappelli, Francesco; Bolognese, Leonardo; Pieroni, Maurizio; Olivotto, Iacopo

doi:10.1016/j.ijcard.2020.07.036

Cited by 20 publications

(11 citation statements)

References 20 publications

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“…Additionally, the extent of post-ASA myocardial scar tissue should not induce significant arrhythmogenic events or heart failure. It is important to note, however, that apart from the amount of injected alcohol, a range of factors including, for example, anatomy of the septal branches, mechanism of subaortic dynamic obstruction and interplay with the mitral apparatus, papillary muscles abnormalities, magnitude of septal thickness, and septal hypertrophy geometry play important roles in decision-making to tailor optimal therapy for each individual HOCM patient [21][22][23][24][25]. Since these and other unmeasured factors were not taken into account in our study it is impossible to establish a specific alcohol dose suitable for all HOCM patients treated with ASA.…”

Section: Discussionmentioning

confidence: 99%

Alcohol dose in septal ablation for hypertrophic obstructive cardiomyopathy

Veselka

Faber

Liebregts

et al. 2021

International Journal of Cardiology

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Background: The aim of this study was to evaluate short-and long-term outcomes related to dose of alcohol administered during alcohol septal ablation (ASA) in patients with hypertrophic obstructive cardiomyopathy (HOCM). Current guidelines recommend using 1-3 mL of alcohol administered in the target septal perforator artery, but this recommendation is based more on practical experience of interventionalists rather than on systematic evidence. Methods: We included 1448 patients and used propensity score to match patients who received a low-dose (1.0-1.9 mL) versus a high-dose (2.0-3.8 mL) of alcohol during ASA. Results: The matched cohort analysis comprised 770 patients (n = 385 in both groups). There was a similar occurrence of 30-day post-procedural adverse events (13% vs. 12%; p = 0.59), and similar all-cause mortality rates (0.8% vs. 0.5%; p = 1) in the low-dose group and the high-dose group, respectively. In the long-term follow-up (5.4 ± 4.5 years), a total of 110 (14%) patients died representing 2.58 deaths and 2.64 deaths per 100 patientyears in the low dose and the high dose group (logrank, p = 0.92), respectively. There were no significant differences in the long-term dyspnea and left ventricular outflow gradient between the two groups. Patients treated with a low-dose of alcohol underwent more subsequent septal reduction procedures (logrank, p = 0.04). Conclusions: Matched HOCM patients undergoing ASA with a low-dose (1.0-1.9 mL) or a high-dose (2.0-3.8 mL) of alcohol had similar short-and long-term outcomes. A higher rate of repeated septal reduction procedures was observed in the group treated with a low-dose of alcohol.

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Section: Discussionmentioning

confidence: 99%

Alcohol dose in septal ablation for hypertrophic obstructive cardiomyopathy

Veselka

Faber

Liebregts

et al. 2021

International Journal of Cardiology

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“…QTc prolongation precluded DOF loading in only 10% of our patients, and contributed to postloading STL discontinuation in 6%, comparable to prior studies 14 . Only 5% of our STL patients had a HF hospitalization over our median 4.4 year follow-up (comparable to HF incidence in a broad HCM population over such a period 21 and not clearly linked to STL's negative inotropy), although some patients did have STL discontinued due to HF concern. Rates of death were reassuringly low across all of our study groups.…”

Section: Discussionmentioning

confidence: 65%

Efficacy and Safety of Dofetilide and Sotalol in Patients With Hypertrophic Cardiomyopathy

Chen

Lal²,

Burton³

et al. 2023

Preprint

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Background Professional society practice guidelines conflict regarding their recommendations of dofetilide (DOF) and sotalol (STL) for treatment of arrhythmias in hypertrophic cardiomyopathy (HCM), and supporting data is sparse. We aim to assess safety and efficacy of DOF and STL on arrhythmias in HCM. Methods This was an observational study of HCM patients treated with DOF or STL for atrial fibrillation (AF) and ventricular arrhythmias (VA). Outcomes of drug discontinuation and arrhythmia recurrence were compared at 1 year and latest follow-up by Kaplan-Meier analysis. Predictors of drug failure were studied using uni- and multi-variable analyses. Drug-related adverse events were quantitated. Results Of our cohort of 72 patients (54 ± 14 years old, 75% male), 21 were prescribed DOF for AF, 52 STL for AF, and 18 STL for VA. At 1 year, discontinuation and recurrence rates were similar for DOF-AF (38% and 43%) and STL-AF (29% and 44%) groups. Efficacy data was similar at long-term follow-up of 1603 (IQR 994–4131) days, and for STL-VA. Drug inefficacy was the most common reason for discontinuation (28%) followed by side-effects (13%). Incidences of heart failure hospitalization (5%) and mortality (3%) were low. One STL-AF patient developed non-sustained torsades de pointes in the setting of severe pneumonia and acute kidney injury, but there were no other drug-related serious adverse events. Conclusion DOF and STL demonstrate moderate efficacy and excellent safety when used for AF and VA in HCM patients.

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“…22 Despite advancements in SCD prevention, there remains an entity of patients manifesting as symptomatic HF that requires frequent hospitalizations. 23 Although studies revealed that symptomatic HF is prevalent (approximately 50%-67%) among patients with HCM, 22 the predictors of HF hospitalization or other disease-related complications have not been comprehensively examined. Prior studies have identified echocardiographic indices as prognostic values.…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies have identified echocardiographic indices as prognostic values. Ciabatti et al 23 demonstrated that larger LA volume at baseline was independently associated with more hospitalizations. A restrictive filling pattern and dilated LV end-diastolic diameter were also reported to be predictors of more cardiovascular deaths.…”

Section: Discussionmentioning

confidence: 99%

Risk stratification in patients with hypertrophic cardiomyopathy: Looking beyond the left side myocardial function

Chang

Cheng

Kuo

et al. 2022

Journal of the Chinese Medical Association

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Background: Patients with hypertrophic cardiomyopathy (HCM) have heterogeneous outcomes. As risk stratification mostly focuses on left-side myocardial function, we sought to investigate the prognostic value of right ventricular (RV) function in patients with HCM. Methods: This retrospective cohort study included patients with HCM. Conventional ventricular functional parameters, including left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE), and fractional area change were obtained. The longitudinal strain was analyzed using the speckle tracking method. The primary endpoint was defined as a composite of hospitalization for heart failure, sustained ventricular tachycardia, or all-cause death. Results: A total of 56 patients with HCM (aged 58.0 ± 14.9 years, 64.3% male) were included. After a mean follow-up duration of 30.1 ± 17.4 months, primary endpoints developed in 10 (20%) of 50 patients who were treated medically. Patients with cardiovascular events had a more reduced LV thickest segmental strain, worse TAPSE, and more impaired RV free wall strain. After adjusting for age, sex, and LVEF, TAPSE (hazard ratio [HR], 95% confidence intervals [CIs]: 0.24, 0.06-0.93) and RV free wall strain (HR, 95% CIs:1.12, 1.03-1.21) remained independent prognostic predictors. Incorporating either TAPSE or RV free wall strain provides incremental prognostic value to the LV strain alone (net reclassification improvement by 31.4% and 34.1%, respectively, both p < 0.05). Conclusion: RV function assessed by TAPSE or RV free wall strain is predictive of subsequent cardiac events, suggesting that a comprehensive evaluation of RV function is useful for risk stratification in patients with HCM.

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Prevalence, causes and predictors of cardiovascular hospitalization in patients with hypertrophic cardiomyopathy

Cited by 20 publications

References 20 publications

Alcohol dose in septal ablation for hypertrophic obstructive cardiomyopathy

Alcohol dose in septal ablation for hypertrophic obstructive cardiomyopathy

Efficacy and Safety of Dofetilide and Sotalol in Patients With Hypertrophic Cardiomyopathy

Risk stratification in patients with hypertrophic cardiomyopathy: Looking beyond the left side myocardial function

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