scholarly journals P1416 Clinical importance of consecutive transthoracic echocardiography in the patients with hypertrophic cardiomyopathy

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
K Kim ◽  
H R Kim ◽  
M G Kang ◽  
H Y Park ◽  
J S Koh ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Wall Thickness ◽  
Transthoracic Echocardiography ◽  
Clinical Importance ◽  
P Value ◽  
Limited Data ◽  
Clinical Predictors ◽  
Total N ◽  
Clinical Benefits

Abstract Funding Acknowledgements nothing OnBehalf nothing Background prediction of outcomes Hypertrophic cardiomyopathy (HCM) have been robustly analyzed with echocardiography. However, there is limited data of serial follow-up (FU) transthoracic echocardiography (TTE) to predict outcomes in patients with HCM. Objectives This study aim is to discover clinical predictors associated with consecutive TTE follow-up in patients with HCM. Methods From 2010 to 2016, 162 patients with HCM were enrolled retrospectively. Concentric LVH and others systolic disease related to wall thickness were excluded. Index TTE (baseline) was measured when firstly admitted in our hospital. FU TTE was analyzed at the end of follow-up, defined as the last recorded value in patients who did not develop events or the last recorded value before events developed. Results The average of FU TTE and clinical FU period was 3.7 ± 2.0 years. Clinical outcomes were defined as stroke, syncope, heart failure, arrhythmia and death. Interestingly, only baseline TR V max was a predictor for clinical outcome whereas the others echo parameters were not associated with events (Table 1). KM curve showed the TR Vmax ≥2.5m/s was also significant (log rank = 0.008, Fig 1.) Conclusions Our study showed short-term FU TTE did not bring clinician with clinical benefits in the aspect of prediction for events. Only baseline TR V max was good correlation with cardiovascular outcomes and even in the survival analysis. Serial TTE and changed values Total N = 162 index TTE (baseline) FU TTE Change of FU per year event no event p-value event no event p-value event no event p-value IVDd, mm 14 ± 4 15 ± 5 0.500 15 ± 5 14 ± 5 0.758 0.23 ± 0.51 -0.07 ± 1.27 0.200 LVIDd, mm 47 ± 5 48 ± 6 0.256 47 ± 7 48 ± 6 0.560 -0.22 ± 2.79 0.10 ± 2.27 0.444 LVEF, % 62 ± 5 61 ± 7 0.379 61 ± 6 61 ± 10 0.927 -0.43 ± 3.10 -0.04 ± 4.94 0.620 LAVI 43 ± 9 43 ± 8 0.879 57 ± 27 58 ± 23 0.849 0.53 ± 14.5 3.11 ± 7.2 0.134 EA ratio 0.9 ± 0.6 0.9 ± 0.6 0.782 1.0 ± 0.8 0.9 ± 0.6 0.595 -0.02 ± 0.76 0.003 ± 0.027 0.594 DT,ms 196 ± 58 201 ± 62 0.603 203 ± 91 217 ± 89 0.370 17 ± 57 5 ± 40 0.154 septal e` 4.4 ± 2.1 4.2 ± 1.6 0.585 4.4 ± 1.6 4.6 ± 1.7 0.438 0.24 ± 0.91 0.05 ± 0.65 0.190 E of e` 17 ± 11 17 ± 23 0.993 15 ± 9 15 ± 6 0.726 -0.48 ± 4.42 -1.66 ± 22.78 0.728 TR velocity 2.6 ± 0.5 2.4 ± 0.4 0.012 2.7 ± 0.6 2.6 ± 0.4 0.604 0.05 ± 0.30 0.04 ± 0.18 0.905 Max wall thickness 17 ± 3 18 ± 3 0.137 17 ± 4 17 ± 3 0.888 -0.01 ± 2.19 -0.18 ± 1.14 0.522 Abstract P1416 Figure. TR Vmax and CV outcomes in the KM curve

scholarly journals 813 The added value of transthoracic three dimensional echocardiography in apical hypertrophic cardiomyopathy

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Valeria Rella ◽  
Mara Gavazzoni ◽  
Michele Tomaselli ◽  
Giorgio Oliverio ◽  
Valentina Volpato ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Sudden Cardiac Death ◽  
Wall Thickness ◽  
Cardiac Death ◽  
Contrast Echocardiography ◽  
Three Dimensional ◽  
Added Value ◽  
Maximal Wall Thickness ◽  
Apical Hypertrophy

Abstract We present the case of a 73-year-old patient with a recent diagnosis of hypertrophic cardiomyopathy (HCM). He was asymptomatic and has no family history of sudden cardiac death (SCD), syncope or ventricular arrhythmias. An echocardiogram performed at the moment of diagnosis (2020), showed left ventricular (LV) asymmetric apical hypertrophy with maximal wall thickness of 21 mm. Cardiac magnetic resonance (CMR) confirmed LV apical hypertrophy with mid-ventricular obliteration, and late gadolinium enhancement in the apical segments, without wall motion abnormalities present at rest. According to 2014 ESC guidelines, his calculated risk score for sudden cardiac death was low (1.23% at 5 years). On 2021, a comprehensive transthoracic echocardiographic examination including advanced techniques (three-dimensional echo-3DE-, and two-dimensional speckle-tracking-2DSTE) was done as part of his routine follow-up in our cardiomyopathy outpatient clinic. The echo study showed an asymmetric pattern of LV hypertrophy with a maximal wall thickness of 21 mm at the level of the anterolateral apical segment, normal LV volumes (end-diastolic volume 55 mL/m2) and ejection fraction (69%) by 3DE. LV longitudinal strain analysis by 2DSTE showed impaired LV myocardial deformation mainly at the apical LV segments (GLS = −13.6%). There was evidence of dynamic intracavitary obstruction (maximal gradient 32 mmHg at rest and raised to 52 mmHg during Valsalva manoeuvre). 3DE views of the LV (both multi-slice display and 3D rendered image) allowed to avoid foreshortening of the LV apical views, and to appreciate the actual wall motion at the real LV apex. They revealed a LV apical aneurysm which was not detected in the conventional LV-focused apical 2D views (Figure 1A and B). Apical hypertrophic cardiomyopathy (ApHCM) is a variant of HCM that is characteristic of focal thickening of the LV apical myocardium and was reported to have a more benign course than other non-apical forms. However, the presence of LV aneurysm in ApHCM patients is associated with an increased risk for ventricular arrhythmias, sudden cardiac death and thromboembolism. Accordingly, the detection of apical LV aneurysms has significant impact on patient management. Guidelines recommend the use of contrast echocardiography or CMR when the apical region of the LV is suboptimally visualized by conventional 2D echocardiography. However, contrast echocardiography may still be affected by apical foreshortening resulting in suboptimal accuracy, as it is a 2D technique. On the other end, CMR may be contraindicated or not widely available for routine yearly follow-up for all HCM patients requiring regular imaging follow-up. Our clinical case emphasizes the added value of 3DE to increase the sensitivity of transthoracic echocardiography in detecting apical LV aneurysms in patients with apical HCM with important clinical implications for the management of the patient. 813 Figure 1(A) 2D 4chamber-view showing maximal wall thickness in the apical segments (21 mm) with apical obliteration. At a first evaluation, apical aneurism is not easily detected. (B) 4D rendering of the apex showing the apical aneurism.

scholarly journals 585 Natural history of left ventricular hypertrophy in infants of diabetic mothers

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Emanuele Monda ◽  
Federica Verrillo ◽  
Michele Lioncino ◽  
Ippolita Altobelli ◽  
Martina Caiazza ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Wall Thickness ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
P Value ◽  
Z Score ◽  
Benign Condition ◽  
Infants Of Diabetic Mothers ◽  
Diabetic Mothers

Abstract Aims This study sought to describe the characteristics and the natural course of left ventricular hypertrophy (LVH) in a well-characterized consecutive cohort of infants of diabetic mothers (IDMs). Methods and results Sixty consecutive IDMs with LVH have been retrospectively identified and enrolled in the study. All IDMs were evaluated at baseline and every 6 months until LV wall thickness regression, defined as the decrease of wall thickness measurement into the normal reference range for cardiac parameters (z-score > −2 and <2). A comprehensive assessment was performed in those patients with diagnostic markers suggestive of a different cause and/or without significant reduction of the LVH during follow-up. At 1-year follow-up, all IDMs showed a significant reduction of maximal wall thickness MWT [6.00 mm (IQR: 5.00–712) vs. 5.50 mm (IQR: 5.00–6.00), P-value <0.001; MWT-z-score: 4.86 (IQR: 3.93–7.61) vs. 1.72 (IQR: 1.08–2.85), P-value <0.001] compared to baseline, and all patients showed LV wall thickness regression or residual mild or moderate LVH (57%, 28%, and 12%, respectively), except two patients with persistent severe LVH, that after a comprehensive clinical-genetic assessment were diagnosed as Noonan syndrome with multiple lentigines. At multivariate analysis, MWT was negatively associated with LV wall thickness regression at 1-year follow-up [MWT-mm: OR: 0.48 (0.29–0.79), P-value = 0.004; MWT-z-score: OR: 0.71 (0.56–0.90), P-value = 0.004]. Conclusions LVH in IDMs represents a benign condition with complete regression during the first years of life. In those patients without LV wall thickness regression, combined with clinical markers suggesting a specific disease, a complete work-up is required for a definite diagnosis.

scholarly journals Automatic Electrocardiogram Detection of Suspected Hypertrophic Cardiomyopathy: Application to Wearable Heart Monitors

2021 ◽  
Author(s):  
Max Denis ◽  
Mulatu Bachoro ◽  
Winta Gebreslassie ◽  
Timothy Oladunni
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Left Ventricular Hypertrophy ◽  
Healthy Volunteers ◽  
Ventricular Hypertrophy ◽  
Detection Algorithm ◽  
Left Ventricular ◽  
P Value ◽  
S Wave ◽  
Healthy Human ◽  
Total N

In this work, an automatic detection algorithm for hypertrophic cardiomyopathy (HCM) is presented. Of particular interest is the ability of the algorithm to differentiate HCM subjects and healthy volunteers from a single lead ECG dataset. Suspected HCM subjects are identified by the primary clinical abnormality associated with HCM, left ventricular hypertrophy (LVH). In total, n=43 human subjects ECG datasets are investigated: n=21 healthy volunteers and n=22 left ventricular hypertrophy (LVH) patients. Significant differences of p-value 0.01 and 0.04 were found for the respective ECG parameters, S-wave amplitude and ST-segment, when differentiating between the LVH patients and healthy human volunteers.

Dietary fat in relation to overall and progression-free survival among patients (pts) with advanced or metastatic colorectal cancer (CRC): Data from CALGB 80405 (Alliance).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 3588-3588
Author(s):  
Erin Van Blarigan ◽  
Chao Ma ◽  
Fang-Shu Ou ◽  
Alan P. Venook ◽  
Kimmie Ng ◽  
...  
Keyword(s):  
Dietary Fat ◽  
Controlled Trial ◽  
Saturated Fat ◽  
Dietary Factors ◽  
P Value ◽  
Fat Intake ◽  
Total N ◽  
Long Chain ◽  
Vegetable Fat

3588 Background: Growing data suggest dietary factors are associated with survival among pts with non-metastatic CRC. However, data on diet and survival among pts with advanced or metastatic disease are very limited. Methods: We prospectively examined dietary fat intake assessed at initiation of treatment for advanced or metastatic CRC in relation to OS and PFS. This analysis was conducted among 1,149 pts in the CALGB 80405 randomized controlled trial who completed a validated food frequency questionnaire. We examined intakes of saturated, monounsaturated, and polyunsaturated (total n-3, long-chain n-3, and total n-6) fats as well as animal and vegetable fats. Based on data from non-metastatic CRC and other cancers, we hypothesized that higher intakes of long-chain n-3 fatty acids and vegetable fats would be associated with longer OS and PFS and higher intakes of saturated fat and animal fat would be associated with shorter OS and PFS. We used Cox proportional hazards regression to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI). Results: Over a median follow-up of 6.1 years [y; interquartile range (IQR): 5.3, 7.2 y], we observed 974 deaths and 103 events of progression without death during follow-up. Participants in this analysis had a median age of 59 y (IQR: 51 to 67 y); 41% were female and 86% identified as white. We observed no statistically significant associations between any type of dietary fat and OS. However, vegetable fat was non-linearly associated with longer PFS (HR comparing 4th to 1st quartile: 0.78; 95% CI: 0.64, 0.96; p-trend: 0.10). We also observed a linear association between continuous saturated fat and PFS (HR per 5% kcal/d: 1.21; 95% CI: 1.03, 1.42; p-value: 0.02), perhaps driven by pts with high saturated fat intake. Conclusions: We observed no statistically significant associations between types of dietary fat and OS among pts with advanced or metastatic CRC. However, a healthy diet that includes vegetable fat and is modest in saturated fat may be associated with longer PFS. Future studies to replicate these findings and examine diet in relation to cancer survival in racially/ethnically diverse populations are needed. Support: K07CA197077, U10CA180821, U10CA180882, https://acknowledgments.alliancefound.org . Clinical trial information: NCT00265850.

scholarly journals P1507 Early and late morphological changes in the athlete"s heart: a longitudinal cohort study in young elite athletes

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A W Bjerring ◽  
H E W Landgraff ◽  
S Leirstein ◽  
M Lihagen ◽  
M Skei ◽  
...  
Keyword(s):  
Endurance Training ◽  
Wall Thickness ◽  
Morphological Changes ◽  
Relative Wall Thickness ◽  
Endurance Athletes ◽  
P Value ◽  
Vo2 Max ◽  
Former Athletes ◽  
Athlete's Heart

Abstract Funding Acknowledgements South-Eastern Norway Regional Health Authority OnBehalf Center for Cardiological Innovation Background Recent studies have suggested an initial concentric remodelling in the early development of the athlete’s heart in endurance athletes. However, the development from the early to the fully developed endurance athlete’s heart has not been described in longitudinal studies. Aims This study aims to explore the morphological changes occurring in hearts of young endurance athletes transitioning through adolescence. Methods Forty-eight cross-country skiers were examined at age 12 (12.1 ± 0.2 years) and then again at age 15 (15.3 ± 0.3 years). Cardiopulmonary exercise test and echocardiography, including 3D acquisitions, was performed in all subjects at both baseline and follow-up. Results At follow-up, 31 (65%) of the endurance athletes were still active and 17 (35%) were not. No differences in cardiac morphology were identified at baseline. At 15 years of age, the active endurance athletes had greater VO2 max, 3D indexed left ventricular end-diastolic and end-systolic volumes (Table). Relative wall thickness (RWT) decreased in the active endurance athletes during follow-up (0.35 ± 0.05 to 0.31 ± 0.04, p < 0.001), but not in the former athletes. Four active endurance athletes had RWT above the upper reference values at baseline; at follow up, all had normalized. Conclusion After an early concentric remodeling in the 12 years old athletes, those who continued regular endurance training developed eccentric changes with chamber dilatation and a drop in RWT. In contrast, those who ceased endurance training maintained a comparable wall thickness, but did not develop chamber dilatation nor experience a drop in RWT. Baseline Follow-up Active athletes (n = 31) Former athletes (n = 17) p-value Active athletes (n = 31) Former athletes (n = 17) p-value VO2 max, indexed 65 ± 7 63 ± 7 0.33 62 ± 8 57 ± 6 <0.05 Interventricular septum thickness, mm 7.9 ± 0.8 7.8 ± 1.0 0.54 8.1 ± 1.2 7.8 ± 0.9 0.41 LV end-diastolic diameter, mm/m2 2.1 ± 0.3 2.0 ± 0.3 0.60 3.0 ± 0.2 2.9 ± 0.2 0.34 LV poster wall thickness, mm 7.3 ± 0.9 6.8 ± 0.9 0.07 7.8 ± 1.2 8.1 ± 1.2 0.42 3D LV end-diastolic volume, mL/m2 76 ± 8 74 ± 8 0.89 84 ± 11 79 ± 10 <0.05 3D LV end-systolic volume, mL/m2 33 ± 4 33 ± 4 0.99 36 ± 6 32 ± 3 <0.05 3D LV ejection fraction, % 56 ± 3 56 ± 3 0.93 58 ± 3 59 ± 2 0.52 3D LV Mass/BSA, g/m2 69 ± 7 71 ± 4 0.57 76 ± 11 74 ± 6 0.19 Relative wall thickness 0.35 ± 0.05 0.33 ± 0.05 0.12 0.31 ± 0.04 0.33 ± 0.05 0.05 Data expressed as mean ± SD. P-values calculated using the Student"s paired t-test. Volumes are indexed to body surface area.

scholarly journals Patients who do not fulfill criteria for hypertrophic cardiomyopathy but have unexplained giant T-wave inversion: a cardiovascular magnetic resonance mid-term follow-up study

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Shuang Li ◽  
Jian He ◽  
Jing Xu ◽  
Baiyan Zhuang ◽  
Bailing Wu ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Hypertrophic Cardiomyopathy ◽  
Magnetic Resonance ◽  
Wall Thickness ◽  
Receiver Operating Curve ◽  
T Wave ◽  
Wave Inversion ◽  
The Mean ◽  
Over Time

Abstract Background Patients who have unexplained giant T-wave inversions but do not meet criteria for hypertrophic cardiomyopathy (HCM) (left ventricular (LV) wall thickness < 1.5 cm) demonstrate LV apical morphological features that differ from healthy subjects. Currently, it remains unknown how the abnormal LV apical morphology in this patient population changes over time. The purpose of this study was to investigate LV morphological and functional changes in these patients using a mid-term cardiovascular magnetic resonance (CMR) exam. Methods Seventy-one patients with unexplained giant T-wave inversion who did not fulfill HCM criteria were studied. The mean interval time of the follow-up CMR was 24.4 ± 8.3 months. The LV wall thickness was measured in each LV segment according to the American Heart Association 17-segmented model. The apical angle (ApA) was also measured. A receiver operating curve (ROC) was used to identify the predictive values of the CMR variables. Results Of 71 patients, 16 (22.5%) progressed to typical apical HCM, while 55 (77.5%) did not progress to HCM criteria. The mean apical wall thickness was significantly different between the two groups at both baseline and follow-up, with the apical HCM group having greater wall thickness at both time points (all p < 0.001). There was a significant difference between the two groups in the change of ApA (− 1.5 ± 2.7°/yr vs. − 0.7 ± 2.0°/yr, p < 0.001) over time. The combination of mean apical wall thickness and ApA proved to be the best predictor for fulfilling criteria for apical HCM with a threshold value of 8.1 mm and 90° (sensitivity 93.8%, specificity 85.5%). Conclusions CMR metrics identify predictors for progression to HCM in patients with unexplained giant T-wave inversion.

Atrial fibrillation in the young: clinical characteristics, predictors of new onset and outcomes

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A Segev ◽  
E Maor ◽  
M Goldenfeld ◽  
E Grossman ◽  
R Beinart ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
P Value ◽  
Bundle Branch Block ◽  
Total N ◽  
Funding Sources ◽  
Conduction Disorders ◽  
Tertiary Center ◽  
Pr Interval ◽  
New Onset

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Atrial fibrillation (AF) onset in the young (≤45 years) is uncommon and not well studied. Purpose Identifying the determinants of AF in this population in order to help direct timely diagnosis, appropriate follow up and management. Methods We retrospectively evaluated all patients aged ≤45, admitted to the internal and cardiology wards between January 2009 and December 2019 at a large tertiary center. Clinical, electrocardiographic and echocardiographic data were collected and compared among patients with and without AF at baseline. A subgroup of patients with no AF at baseline and a subsequent hospital visit were followed for development of new onset AF (NOAF). Results A total of 16,432 patients (55.5% male, 33 ±8.3 years old) were analyzed. At baseline, patients with AF (n = 366) tended to be older, more often male, and had a higher proportion of comorbidities and ECG conduction disorders, compared with the patients without AF (n = 16,066). Male sex, increased age, obesity, heart failure (HF) and the presence of left or right bundle branch block (LBBB and RBBB, respectively) were all strongly and independently associated with young-onset AF. A total of 10,691 patients were followed for a median of 41.5 (16.6-78.6) months, during which 85 patients developed NOAF (equivalent to 0.5%/year). Increased age, hypertension, HF, RBBB and LBBB were independent predictors of NOAF. CHARGE-AF score outperformed CHA2DS2-VASc score in NOAF prediction [AUC of ROC 0.75 (0.7-0.8) vs. 0.56 (0.48-0.65)]. Conclusions The annual risk of NOAF among young adults admitted to the hospital is noteworthy. NOAF may be predicted by clinical risk factors and the CHARGE-AF score. Characteristic No AF (N = 16066) AF (N = 366) Total (N = 16432) P value Age- yr. 33.06 ± 8.3 36.8 ± 7.3 33.1 ±8.3 &lt;0.0001 Male gender 8914 (55.5) 240 (65.6) 9154 (55.7) &lt;0.0001 BMI- kg/m2 25.5 ± 5.75 27.48 ± 6.36 25.2 ± 5.8 &lt;0.0001 HTN 2679 (16.7) 73 (19.9) 2752 (16.7) 0.098 CHF 124 (0.8) 13 (3.6) 137 (0.8) &lt;0.0001 PR interval &gt; 200ms 117 (1.3) 15 (9.1) 132 (1.5) &lt;0.0001 QRS interval &gt; 120ms 220 (2.4) 25 (8.4) 245 (2.6) &lt;0.001 LBBB 29 (0.2) 6 (1.6) 35 (0.2) &lt;0.0001 LVEF &lt; 40 323 (10.1) 35 (16.9) 358 (10.5) 0.002 CHA2DS2-VASc 0.75 ±0.75 0.73 ±0.84 0.74 ±0.76 0.647 CHARGE AF 6.3 ±1.1 6.8 ±0.9 6.32 ±1.06 &lt;0.001

Prognostic role of coronary flow velocity reserve in hypertrophic cardiomyopathy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Tesic ◽  
Q Ciampi ◽  
A Djordjevic-Dikic ◽  
B Beleslin ◽  
L Cortigiani ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Flow Velocity ◽  
Wall Thickness ◽  
Coronary Flow ◽  
Multivariable Analysis ◽  
Coronary Microvascular Dysfunction ◽  
Coronary Flow Velocity Reserve ◽  
Coronary Flow Velocity ◽  
Maximal Wall Thickness

Abstract Background A reduction in coronary flow velocity reserve (CFVR) related to coronary microvascular dysfunction is a major mechanism for ischemia in hypertrophic cardiomyopathy (HCM). Hypothesis To assess the functional correlates and prognostic value of CFVR during stress echocardiography (SE) in HCM. Methods We enrolled 201 HCM patients (age 51±14 years, 105 male, 52%; maximal wall thickness: 18±3 mm) studied with CFVR during exercise (n=33, 16.4%), dipyridamole (n=89, 44.3%) or adenosine (n=79, 39.3%) SE in 6 certified centers. CFVR was assessed using pulsed wave Doppler sampling in left anterior descending coronary artery. All patients completed the clinical follow-up. Results During SE mean value of CFVR was 2.11±0.46. No patients showed regional wall motion abnormalities during stress. LV outflow tract obstruction (LVOTO) was present in 34 (16.9%) patients at rest and in 47 (23.4%) at peak stress. CFVR was inversely related to age (r=−0.229, p=0.001) and maximal wall thickness (r=−0.197, p=0.031). During a median follow-up of 26 months (IQ range: 12–48 months), 75 events in 63 patients occurred: 10 deaths, 33 new hospital admission for acute heart failure, 8 sustained ventricular tachycardias and 24 atrial fibrillations. Patients in the lowest tertile (≤1.88) showed the worse prognosis with higher incidence of follow-up events compared to median tertile (1.89–2.29) and highest tertile (≥2.30) (see figure). At multivariable analysis, NYHA functional class (HR: 2.234, 95% CI: 1.398–3.517, p=0.001), presence of LVOTO at rest (HR: 2.958, 95% CI: 1.074–3.570, p=0.028) and lowest tertile of CFVR (HR: 2.144, 95% CI: 1.126–4.081, p=0.011) were the independent predictors of follow-up events. Conclusions In HCM patients, reduction in CFVR is associated to a clearly worse outcome. The spectrum of prognostic stratification is expanded if the response is titrated according to a continuous scale. Figure 1 Funding Acknowledgement Type of funding source: None

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