Sex-specific relationships between patterns of ventricular remodelling and clinical outcomes

Abstract Aims Left ventricular hypertrophy (LVH) is the most common form of myocardial remodelling and predicts adverse outcomes in patients with coronary artery disease (CAD). However, sex-specific prevalence and prognostic significance of LVH patterns are poorly understood. We investigated the sex-specific influence of LVH pattern on clinical outcomes in patients undergoing cardiovascular magnetic resonance (CMR) and coronary angiography following adjustment for co-morbidities including CAD burden. Methods and results Patients undergoing CMR and coronary angiography between 2005 and 2013 were included. Volumetric measurements of left ventricular (LV) mass with classification of concentric vs. eccentric remodelling patterns were determined from CMR cine images. Multivariable Cox analysis was performed to assess independent associations with the primary outcome of all-cause mortality. In total, 3754 patients were studied (mean age 59.3 ± 13.1 years), including 1039 (27.7%) women. Women were more likely to have concentric remodelling (8.1% vs. 2.1%, P < 0.001), less likely to have eccentric hypertrophy (15.1% vs. 26.8%, P < 0.001) and had a similar prevalence of concentric hypertrophy (6.1 vs. 5.2%, P = 0.296) compared to men. At a median follow-up of 3.7 years, 315 (8.4%) patients died. Following adjustment including CAD burden, concentric hypertrophy was associated with increased all-cause mortality in women [adjusted hazard ratio (HR) 3.48, P < 0.001] and men (adjusted HR 2.57, P < 0.001). Eccentric hypertrophy was associated with all-cause mortality only in women (adjusted HR 1.78, P = 0.047). Conclusion Patterns of LV remodelling differ by sex and LVH and provides prognostic information in both men and women. Our findings support the presence of sex-specific factors influencing LV remodelling.

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Echocardiographic left ventricular geometry profiles for prediction of stroke, coronary heart disease and all-cause mortality in the Chinese community: a rural cohort population study

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02055-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tan Li ◽

Guangxiao Li ◽

Xiaofan Guo ◽

Zhao Li ◽

Yingxian Sun

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Prognostic Significance ◽

Left Ventricular ◽

Adverse Outcomes ◽

Left Ventricular Geometry ◽

Geometric Patterns ◽

Concentric Hypertrophy ◽

All Cause Mortality ◽

Eccentric Hypertrophy

Abstract Background The utility of echocardiographic left ventricular (LV) geometry in the prediction of stroke/coronary heart disease (CHD) and all-cause mortality is not well characterized. This study aimed to evaluate the overall and sex-specific prognostic value of different geometric patterns on the incidence of stroke/CHD and all-cause mortality in a Chinese population-based cohort. Methods We conducted a prospective study in the general population in Northeast China, and a total of 9940 participants aged ≥ 35 years underwent echocardiography for LV geometry and were successfully followed up for incident stroke/CHD and all-cause death. Cox proportional hazards models were utilized to estimate the association of baseline LV geometry with adverse outcomes. Results Over a median follow-up of 4.66 years, abnormal LV geometric patterns had increased crude incident rates of stroke/CHD and all-cause mortality compared with normal geometry in overall population and each sex group (all P < 0.05). Multivariable Cox analysis reported that LV concentric and eccentric hypertrophy were associated with incident stroke/CHD (concentric hypertrophy: hazard ratio (HR) = 1.39, 95% confidence interval (CI) = 1.04–1.86; eccentric hypertrophy: HR = 1.42, 95% CI = 1.11–1.82) and all-cause mortality (concentric hypertrophy: HR = 1.50, 95% CI = 1.07–2.12; eccentric hypertrophy: HR = 1.58, 95% CI = 1.19–2.10), and LV concentric remodeling was related to stroke/CHD incidence (HR = 1.42, 95% CI = 1.09–1.84) in total population compared to normal geometry after the adjustment for potential confounders. In men, a significant increase was observed from LV eccentric hypertrophy for incident stroke/CHD, whereas in women, LV concentric hypertrophy was associated with elevated incidence of both stroke/CHD and all-cause death, and eccentric hypertrophy was correlated with increased all-cause mortality (all P < 0.05). Conclusions Our prospective cohort supports that abnormal LV geometry by echocardiography has a prognostic significance for incident stroke/CHD and all-cause mortality, implying that early detection and intervention of LV structural remodeling in rural China are urgently needed to prevent adverse outcomes.

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Sex differences in left ventricular remodeling in patients with severe aortic valve stenosis

European Heart Journal ◽

10.1093/eurheartj/ehab724.0114 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

J H Kuneman ◽

G K Singh ◽

S Milhorini Pio ◽

K Hirasawa ◽

N Ajmone Marsan ◽

...

Keyword(s):

Sex Differences ◽

Aortic Valve ◽

Aortic Valve Stenosis ◽

Left Ventricular ◽

Concentric Hypertrophy ◽

Lv Mass ◽

Lv Remodeling ◽

All Cause Mortality ◽

Eccentric Hypertrophy ◽

Lv Volumes

Abstract Background Women with severe aortic valve stenosis (AS) have better long-term outcomes after transcatheter aortic valve implantation (TAVI) but worse survival after surgical aortic valve replacement compared to men. Whether this is related to sex differences in left ventricular (LV) remodeling is unknown. Purpose To examine sex differences in LV remodeling and outcomes in patients with severe AS undergoing TAVI. Methods Patients with severe AS who underwent TAVI between 2007 and 2018 with a pre-procedural multidetector row computed tomography (MDCT) scan were included. LV volumes, mass and function were analyzed with MDCT. Patients were classified into 4 LV remodeling patterns based on LV mass index and LV mass-to-volume ratio: 1) normal geometry, 2) concentric remodeling, 3) concentric hypertrophy and 4) eccentric hypertrophy. The primary endpoint was all-cause mortality after TAVI. Results A total of 289 patients (age 80±6 years, 54% male) were included. Women showed smaller LV volumes and mass compared to men. Concentric hypertrophy (50%) was the most frequent pattern of LV remodeling followed by eccentric hypertrophy (33%), normal geometry (13%) and concentric remodeling (4%). Concentric remodeling was more frequently observed in men compared to women (91% vs. 9% respectively, p=0.011). However, no sex differences were observed in the remaining LV remodeling patterns (Figure 1). During a median follow-up of 3.8 (IQR 2.2–5.1) years after TAVI, 87 patients died. Women demonstrated better outcome after TAVI compared to men (log-rank χ2=4.29, p=0.038). The survival benefit of women over men was mainly present among patients with concentric hypertrophy (log-rank χ2=4.91, p=0.027, Figure 2). Conclusion LV concentric and eccentric hypertrophy are similarly observed in men and women with severe AS. Women demonstrated better outcome after TAVI as compared to men, particularly among those with LV concentric hypertrophy. However, the outcome benefit of females after TAVI seems not to be related to sex-differences in LV remodeling. FUNDunding Acknowledgement Type of funding sources: None. Distribution of sex in LV remodeling All-cause mortality after TAVI

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Difference of Clinical Outcomes According to Left Ventricular Hypertrophy and Its Subtype in Korean Patients with Acute Myocardial Infarction

Korean Journal of Medicine ◽

10.3904/kjm.2020.95.6.387 ◽

2020 ◽

Vol 95 (6) ◽

pp. 387-397

Author(s):

Hui Jeong Kim ◽

Myung Ho Jeong ◽

Hyun Ju Yoon ◽

Yong Cheol Kim ◽

Seok-Joon Sohn ◽

...

Keyword(s):

Myocardial Infarction ◽

Clinical Outcomes ◽

Ventricular Hypertrophy ◽

Left Ventricular ◽

Left Ventricular Geometry ◽

Korean Patients ◽

Ventricular Geometry ◽

Concentric Hypertrophy ◽

Normal Left Ventricular ◽

Eccentric Hypertrophy

Background/Aims: Left ventricular hypertrophy (LVH) on clinical outcomes in patients with acute myocardial infarction (AMI) is not clear. This study was performed to investigate the effect of abnormal left ventricular geometry on clinical outcomes in Korean patients with AMI.Methods: A total of 852 consecutive patients with AMI were divided into two groups: normal left ventricular geometry (n = 470; 389 males) and LVH (n = 382; 214 males) groups. Major adverse cardiac events (MACEs) were defined as cardiac death, recurrent myocardial infarction, and rehospitalization.Results: During the clinical follow-up period of 21 ± 7.8 months, MACEs developed in 173 patients (20.0%), and the rate was higher in the LVH than normal left ventricular geometry groups (25.5% vs. 16.0%, respectively, p = 0.001). According to Kaplan-Meier survival curves, the MACE-free survival rate was significantly lower in the LVH group than in the left ventricular geometry group (p = 0.008). The rates of MACEs and all-cause mortality differed among the AMI with concentric remodeling, concentric hypertrophy, and eccentric hypertrophy subgroups (11.2% vs. 15.5% vs. 22.1%, respectively, p = 0.046). Eccentric hypertrophy was a predictive factor of MACE according to Cox proportional hazards analysis (hazard ratio 1.804, confidence interval 1.034-3.148, p = 0.038).Conclusions: LVH is a predictor of poor outcomes in patients with AMI, and eccentric hypertrophy is associated with a worse prognosis compared with concentric remodeling and concentric hypertrophy. Therefore, Korean patients with AMI and LVH, especially eccentric hypertrophy, require more careful observation and intensive treatment.

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Abstract 4204: Impact of Left Ventricular Diastolic Functional Reserve on Clinical Outcome in Patients with Diabetes Mellitus

Circulation ◽

10.1161/circ.118.suppl_18.s_842-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Sung Ai Kim ◽

Sang Jae Rhee ◽

Chi-Young Shim ◽

Sungha Park ◽

Donghoon Choi ◽

...

Keyword(s):

Heart Disease ◽

Clinical Outcome ◽

Diastolic Dysfunction ◽

Prognostic Significance ◽

Left Ventricular ◽

Adverse Outcomes ◽

Prognostic Information ◽

Functional Reserve ◽

End Point ◽

Patients With Diabetes

Left ventricular (LV) longitudinal diastolic functional reserve, assessed by the change of early diastolic mitral annular velocity (E′) during exercise, is abnormal in patients with diabetes without overt heart disease. However, its impact on clinical outcome has not been explored previously. We hypothesized that LV diastolic reserve could further stratify diastolic dysfunction, and have a prognostic significance in patients with diabetes. Of 1,170 patients who were referred for diastolic stress echocardiography, 227 consecutive patients (mean age 58 years, male 103, mean ejection fraction [EF] 68 %) with diabetes were identified. LV diastolic function reserve index (DFRI) was calculated as E′ base x ΔE′; where ΔE′ is the change of E′ from baseline to exercise. The primary end-point was a composite of all-cause death and re-hospitalization for heart failure. The median follow-up duration was 34 months, and the primary end-point was occurred in 14 (6.1%) of 227 patients. Among the predictors that showed a significance in the univariate Cox analysis, including age, coronary artery disease history, renal insufficiency, LV mass index, LAVI, and EF, LV DFRI was the most independent predictor of adverse outcomes. When patients were classified by the median value of DFRI at 50W of exercise, patients with DFRI < 13.5 showed poorer clinical outcomes compared to those with DFRI ≥ 13.5 (p=0.001). The assessment of LV diastolic functional reserve using exercise Doppler echocardiography is helpful in further stratifying diastolic dysfunction, and provides incremental prognostic information in patients with diabetes without overt heart disease.

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Abstract 53: Biomarkers of Cardiovascular Stress and Left Ventricular Hypertrophic Patterns: Cross-sectional relations and prognostic significance

Circulation ◽

10.1161/circ.129.suppl_1.53 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Vanessa Xanthakis ◽

Meredith Stevenson ◽

Ramachandran S Vasan

Keyword(s):

Troponin I ◽

Prognostic Significance ◽

High Sensitivity ◽

Left Ventricular ◽

Cross Sectional ◽

Cardiac Stress ◽

Concentric Hypertrophy ◽

Hazard Ratios ◽

Unit Increase ◽

Eccentric Hypertrophy

Background: Cardiac stress biomarkers (growth differentiation factor 15 [GDF-15], soluble ST-2 [ST2], high-sensitivity troponin I [hsTnI]) and B-type natriuretic peptide [BNP]) are associated with incident heart failure (HF) and left ventricular mass (LVM). It is unclear if biomarker levels and their prognostic significance vary according to LV hypertrophy (LVH) pattern and extent. We hypothesized that concentric & eccentric LVH would be associated with highest biomarker levels; presence of both LVH and higher biomarker levels would indicate high HF risk. Methods and Results: We evaluated 2,425 Framingham Study participants free of HF (57% women, mean age 58 years) attending a routine examination, with available biomarker and echocardiographic measurements. We defined 4 LVH patterns: a. normal (normal LVM and Relative Wall Thickness [RWT]); b. concentric remodeling (normal LVM, elevated RWT); c. eccentric hypertrophy (elevated LVM, normal RWT); and d. concentric hypertrophy (elevated LVM and RWT). Adjusting for age & sex, biomarker levels (except BNP) increased sequentially across LVH patterns a-d ( Figure ). BNP levels were lowest in concentric remodeling and highest in eccentric LVH. In multivariable models, all biomarkers were associated with incident HF (106 cases, 12 yrs follow-up). We observed a significant interaction only between BNP and LVM (p=0.02). In stratified analyses, higher LVM was associated with incident HF in both BNP strata (Hazard Ratios [HR] per SD increase in LVM = 2.24 [<median BNP] and 1.35 [≥median BNP]; p<0.01 for both). However, higher BNP was associated with incident HF only in the stratum with LVM<median (HR = 2.09 per unit-increase in logBNP, p=0.003). Conclusions: In our large community-based sample, cardiac stress biomarker levels varied by LVH pattern. Contrary to our hypothesis, BNP levels were more strongly associated with HF in individuals with lesser degree of LVH.

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Echocardiographic Assessment of Left Ventricular Geometric Patterns in Hypertensive Patients in Nigeria

Clinical Medicine Insights Cardiology ◽

10.4137/cmc.s12727 ◽

2013 ◽

Vol 7 ◽

pp. CMC.S12727 ◽

Cited By ~ 1

Author(s):

Rasaaq A. Adebayo ◽

Olaniyi J. Bamikole ◽

Michael O. Balogun ◽

Anthony O. Akintomide ◽

Victor O. Adeyeye ◽

...

Keyword(s):

Diastolic Dysfunction ◽

Systolic Function ◽

Left Ventricular ◽

Geometric Pattern ◽

Color Flow ◽

Hypertensive Patients ◽

Geometric Patterns ◽

Concentric Hypertrophy ◽

Eccentric Hypertrophy ◽

Lv Systolic Function

Left ventricular (LV) hypertrophy is an important predictor of morbidity and mortality in hypertensive patients, and its geometric pattern is a useful determinant of severity and prognosis of heart disease. Studies on LV geometric pattern involving large number of Nigerian hypertensive patients are limited. We examined the LV geometric pattern in hypertensive patients seen in our echocardiographic laboratory. A two-dimensional, pulsed, continuous and color flow Doppler echocardiographic evaluation of 1020 consecutive hypertensive patients aged between 18 and 91 years was conducted over an 8-year period. LV geometric patterns were determined using the relationship between the relative wall thickness and LV mass index. Four patterns of LV geometry were found: 237 (23.2%) patients had concentric hypertrophy, 109 (10.7%) had eccentric hypertrophy, 488 (47.8%) had concentric remodeling, and 186 (18.2%) had normal geometry. Patients with concentric hypertrophy were significantly older in age, and had significantly higher systolic blood pressure (BP), diastolic BP, and pulse pressure than those with normal geometry. Systolic function index in patients with eccentric hypertrophy was significantly lower than in other geometric patterns. Doppler echocardiographic parameters showed some diastolic dysfunction in hypertensive patients with abnormal LV geometry. Concentric remodeling was the most common LV geometric pattern observed in our hypertensive patients, followed by concentric hypertrophy and eccentric hypertrophy. Patients with concentric hypertrophy were older than those with other geometric patterns. LV systolic function was significantly lower in patients with eccentric hypertrophy and some degree of diastolic dysfunction were present in patients with abnormal LV geometry.

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Abstract 14453: Ventilatory Inefficiency Associated With Stage a Heart Failure

Circulation ◽

10.1161/circ.142.suppl_3.14453 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Elizabeth L Potter ◽

Mary N Woessner ◽

Christopher Neil ◽

Thomas H Marwick ◽

Erin Howden

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Ventilatory Threshold ◽

Global Longitudinal Strain ◽

Prognostic Significance ◽

Cardiopulmonary Exercise Testing ◽

Left Ventricular ◽

Prognostic Information ◽

Risk Profiling ◽

Sedentary Subjects

Introduction: Peak oxygen utilisation (VO 2 ) and ventilatory efficiency (VE/VCO 2 slope) provide strong prognostic information in symptomatic heart failure (HF). Transition from subclinical to symptomatic HF is poorly understood. Cardiopulmonary exercise testing (CPET) in subclinical HF may advance risk profiling. Hypothesis: HF risk factors are associated with metabolic and ventilatory abnormalities that may serve as risk markers. Methods: Sedentary subjects (n=81; 67 (66-72) years; 65% female; BMI 29.9[26.6-33.9] kg/m 2 ) with ≥1 HF risk factors (Stage A HF, SAHF) without pulmonary disease and healthy sedentary subjects (controls, n=21; 70 (67-73) years; 52% female; BMI 25.1 [24-25.9] kg/m 2 ) underwent treadmill CPET to determine peak VO 2 , ventilatory threshold (VT, V-slope method) and VE/VCO 2 slope (linear regression). Global longitudinal strain≤16%, diastolic dysfunction or left ventricular hypertrophy defined subclinical left ventricular dysfunction (LVD). Results: LVD was present in 41 (51%) with SAHF. CPET parameters did not differ by presence of LVD. There were no differences in peak RER or VT (% peak VO2) between controls and SAHF. VO 2 peak was higher in controls vs. SAHF (22.1±4.6 vs. 19.9±4.6ml/kg/min, p=0.047). VE/VCO 2 slope was markedly steeper in SAHF vs. controls (40.2±6.2 vs. 29.3±6.1, p<0.001) (Figure). VE/VCO 2 slope was >34 (prognostic in symptomatic HF) in 83% vs. 19% for SAHF vs. controls (p<0.001). BMI was the only independent predictor (β 0.45 (0.19-0.72, p=0.001) (r 2 0.16) of VE/VCO 2 slope (SBP and heart rate reserve were not). BMI was not associated with increment in respiratory rate or tidal volume (β0.18(-0.07-0.42) and β3.9 (-10.8-18.7)). Conclusions: Cardiorespiratory exercise parameters do not differ in SAHF by presence of LVD. Ventilatory inefficiency is pronounced in SAHF compared with healthy controls suggesting it may be a risk marker, but prognostic significance is unknown.

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Abstract P092: Longitudinal Impact Of Blood Pressure On Left Ventricular Geometry In The Hispanic Community Health Study/Study Of Latinos: Echocardiographic Study Of Latinos (Echo-SOL) Ancillary Study

Circulation ◽

10.1161/circ.143.suppl_1.p092 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Jennifer McLeod ◽

Barry E Hurwitz ◽

Daniela Sotres-Alvarez ◽

Mayank M Kansal ◽

Katrina Swett ◽

...

Keyword(s):

Blood Pressure ◽

Left Ventricular ◽

Health Study ◽

Left Ventricular Geometry ◽

Longitudinal Impact ◽

Ventricular Geometry ◽

Concentric Hypertrophy ◽

Echocardiographic Study ◽

Eccentric Hypertrophy ◽

Latino Adults

Introduction: Abnormal left ventricular geometry (LVG) is an independent predictor of cardiovascular mortality. We assessed the longitudinal transitions of LVG among Hispanic/Latino adults. Methods: Echo-SOL provided serial 2D echocardiograms of Hispanic adults. Each subject was identified as hypertensive or normotensive and categorized into four LVG patterns: normal, concentric remodeling (CR), concentric hypertrophy (CH), or eccentric hypertrophy (EH). Hypertensive adults were stratified on whether they maintained blood pressure (BP) control (<140/90mmHg) by visit 2. The normotensive adults were stratified on whether they developed incident hypertension (HTN) by visit 2. Logistic regression was used to evaluate the outcome of normal vs. abnormal LVG at visit 2 adjusting for age, sex, and follow-up time. Results: There were 1818 adults at visit 1 (mean age 56 years; 42.6% male, 44.7% hypertensive), with 1643 obtaining serial echocardiograms an average of 4.3 years later. At visit 1, LVG was distributed as follows: normal, 65.3%; CR, 30.6%, CH 3.1%, and EH 1.1%. Among hypertensive adults at visit 1, 59.7% had normal LVG and 34.1% had CR. By visit 2, there was a progression from normal LVG to CR among those with and without BP control; CR prevalence increased to 58.5% and 55.2%, respectively (Fig. 1). For visit 1 hypertensive adults, the incidence of abnormal LVG did not differ with regards to BP control (adjusted OR 1.1, 95% CI: 0.7-1.7). Among normotensive adults at visit 1, 69.8% had normal LVG. If they remained normotensive by visit 2, this prevalence decreased to 52.2%. If they developed HTN, there was an associated progression toward abnormal geometry (adjusted OR 2.5, 95% CI: 1.4-4.2), with the majority (59.2%) demonstrating a CR phenotype. Conclusion: Our findings suggest that BP control to 140mmHg is not adequate to prevent progressive LV remodeling among Hispanic/Latino adults. Further study is needed to understand this maladaptive process and how it contributes to cardiovascular disease in this population.

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Co-morbidity (HFrEF and HFpEF): hypertension

ESC CardioMed ◽

10.1093/med/9780198784906.003.0415_update_002 ◽

2018 ◽

pp. 1808-1812

Author(s):

Francesco Paneni ◽

Massimo Volpe

Keyword(s):

Blood Pressure ◽

Ejection Fraction ◽

Left Ventricular ◽

Ventricular Dilation ◽

Hypertensive Patients ◽

Reduced Ejection Fraction ◽

Concentric Hypertrophy ◽

Drug Classes ◽

Left Ventricular Dilation ◽

Eccentric Hypertrophy

Hypertensive heart disease is a major cause of heart failure (HF) and mortality. Hypertension precedes HF occurrence in 75% of cases, and carries a sixfold increase in HF risk as compared to non-hypertensive individuals. Most importantly, a minority of patients survive 5 years after the onset of hypertensive HF. In hypertensive patients, the heart may present different patterns of adaptive remodelling: concentric remodelling, concentric hypertrophy, and eccentric hypertrophy. Although most hypertensive patients are at high risk of developing concentric hypertrophy, a growing proportion of subjects display a concentric-to-eccentric progression eventually leading to left ventricular dilation and systolic dysfunction. Several factors including myocardial ischaemia, ethnicity, genetic background, history of diabetes, and blood pressure pattern may significantly influence the pathway from hypertension to left ventricular dilation. Patients with a concentric hypertrophy usually develop HF with preserved ejection fraction (HFpEF), whereas those with an eccentric (dilated) phenotype develop HF with reduced ejection fraction (HFrEF). Lowering blood pressure has a striking effect in reducing the risk of HF. Although available antihypertensive drugs are all successful in lowering blood pressure, angiotensin-converting enzyme inhibitors, angiotensin receptor blocker (ARBs), and diuretics are more effective than other drug classes in preventing HF. The combination of the neprilysin inhibitor sacubitril with the ARB valsartan (LCZ696) has recently been shown to be highly effective in reducing HF-related outcomes in hypertensive subjects. An individualized treatment scheme taking into account blood pressure levels, type of HF (HFpEF or HFrEF), and relevant co-morbidities (i.e. renal disease, diabetes) is currently the best approach to improve morbidity and mortality in hypertensive patients with HF.

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Prognostic Significance of Fragmented QRS in Patients with Hypertrophic Cardiomyopathy

Cardiology ◽

10.1159/000471845 ◽

2017 ◽

Vol 138 (1) ◽

pp. 26-33 ◽

Cited By ~ 3

Author(s):

Xili Lu ◽

Wei Wang ◽

Ling Zhu ◽

Yilu Wang ◽

Kai Sun ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Clinical Outcomes ◽

Cox Regression ◽

Prognostic Significance ◽

Cox Regression Analysis ◽

Fragmented Qrs ◽

All Cause Mortality ◽

The Relationship ◽

Cvd Mortality

Objectives: The relationship between a fragmented QRS (fQRS) and clinical outcomes in patients with hypertrophic cardiomyopathy (HCM) remains unclear. This study aimed to investigate the prognostic significance of fQRS in patients with HCM. Methods: Between 2000 and 2012, 326 unrelated patients with HCM (72% male with a mean age of 52 years) were included and were divided into 2 groups: those with fQRS and those without fQRS. Results: A total of 105/326(32.2%) patients with HCM presented with fQRS at enrollment. During a follow-up of 5.3 ± 2.4 years, 33 patients died, 30 of cardiovascular disease (CVD). Cox regression analysis revealed that fQRS predicted a higher risk of all-cause mortality (adjusted hazard ratio [HR] 2.24; 95% confidence interval [CI] 1.08-4.64; p = 0.030) and CVD mortality (adjusted HR 2.68; 95% CI 1.22-5.91; p = 0.014). Our study also showed that fQRS increased the risk of heart failure-related death (adjusted HR 3.75; 95% CI 1.24-11.30; p = 0.019). Conclusions: Our results indicate that fQRS is associated with adverse clinical outcomes in patients with HCM.

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