Long-Term Prognosis after Myectomy in Hypertrophic Obstructive Cardiomyopathy with Severe Left Ventricular Hypertrophy

Cardiology ◽  
2018 ◽  
Vol 139 (2) ◽  
pp. 83-89 ◽  
Author(s):  
Shuoyan An ◽  
Chaomei Fan ◽  
Yinjian Yang ◽  
Fei Hang ◽  
Zhimin Wang ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Cox Regression ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Cardiovascular Death ◽  
Left Ventricular ◽  
Medical Group ◽  
Cox Regression Analysis

Objectives: Patients with hypertrophic obstructive cardiomyopathy (HOCM) and severe left ventricular hypertrophy (maximal left ventricular wall thickness ≥30 mm) are at high risk of sudden cardiac death (SCD). In this study, we aimed to determine whether HOCM patients with severe hypertrophy had a lower incidence of SCD after myectomy. Methods: HOCM patients with severe hypertrophy were consecutively enrolled from Fuwai Hospital in China between 2000 and 2013. Long-term outcomes were retrospectively compared between the 2 groups, namely the myectomy group and medical group. Results: A total of 244 patients (118 in the myectomy group and 126 in the medical group) were involved. The mean follow-up durations for the myectomy and medical groups were 5.07 ± 3.73 and 6.23 ± 4.15 years, respectively. During the follow-up period, the annual cardiovascular mortality rate was 0.84% in the myectomy group and 2.04% in the medical group (p = 0.041). The annual SCD rate was 0.33% in the myectomy group and 1.40% in the medical group (p = 0.040). Multivariate Cox regression analysis showed that myectomy was independently associated with lower rates of cardiovascular death and SCD. Conclusions: In HOCM patients with severe hypertrophy, those that underwent myectomy had a lower risk of cardiovascular death and SCD than those treated with medicines only.

scholarly journals Evaluation of different late left ventricular remodeling definitions for predicting long-term outcomes in acute myocardial infarction patients undergoing percutaneous coronary intervention

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Zhang ◽  
X Xie ◽  
C He ◽  
X Lin ◽  
M Luo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ventricular Remodeling ◽  
Cox Regression ◽  
Left Ventricular Remodeling ◽  
Left Ventricular ◽  
Long Term Outcomes ◽  
Cox Regression Analysis ◽  
Long Term Mortality

Abstract Background Late left ventricular remodeling (LLVR) after the index acute myocardial infarction (AMI) is a common complication, and is associated with poor outcome. However, the optimal definition of LLVR has been debated because of its different incidence and influence on prognosis. At present, there are limited data regarding the influence of different LLVR definitions on long-term outcomes in AMI patients undergoing percutaneous coronary intervention (PCI). Purpose To explore the impact of different definitions of LLVR on long-term mortality, re-hospitalization or an urgent visit for heart failure, and identify which definition was more suitable for predicting long-term outcomes in AMI patients undergoing PCI. Methods We prospectively observed 460 consenting first-time AMI patients undergoing PCI from January 2012 to December 2018. LLVR was defined as a ≥20% increase in left ventricular end-diastolic volume (LVEDV), or a >15% increase in left ventricular end-systolic volume (LVESV) from the initial presentation to the 3–12 months follow-up, or left ventricular ejection fraction (LVEF) <50% at follow up. These parameters of the cardiac structure and function were measuring through the thoracic echocardiography. The association of LLVR with long-term prognosis was investigated by Cox regression analysis. Results The incidence rate of LLVR was 38.1% (n=171). The occurrence of LLVR according to LVESV, LVEDV and LVEF definition were 26.6% (n=117), 31.9% (n=142) and 11.5% (n=51), respectively. During a median follow-up of 2 years, after adjusting other potential risk factors, multivariable Cox regression analysis revealed LLVR of LVESV definition [hazard ratio (HR): 2.50, 95% confidence interval (CI): 1.19–5.22, P=0.015], LLVR of LVEF definition (HR: 16.46, 95% CI: 6.96–38.92, P<0.001) and LLVR of Mix definition (HR: 5.86, 95% CI: 2.45–14.04, P<0.001) were risk factors for long-term mortality, re-hospitalization or an urgent visit for heart failure. But only LLVR of LVEF definition was a risk predictor for long-term mortality (HR: 6.84, 95% CI: 1.98–23.65, P=0.002). Conclusions LLVR defined by LVESV or LVEF may be more suitable for predicting long-term mortality, re-hospitalization or an urgent visit for heart failure in AMI patients undergoing PCI. However, only LLVR defined by LVEF could be used for predicting long-term mortality. FUNDunding Acknowledgement Type of funding sources: None. Association Between LLVR and outcomes Kaplan-Meier Estimates of the Mortality

Increasing ambulatory pulse pressure predicts the development of left ventricular hypertrophy during long-term follow-up

2018 ◽  
Vol 32 (3) ◽  
pp. 180-189 ◽  
Author(s):  
Tero J. W. Pääkkö ◽  
Juha S. Perkiömäki ◽  
Y. Antero Kesäniemi ◽  
Antti S. Ylitalo ◽  
Jarmo A. Lumme ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Pulse Pressure ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Long Term Follow Up ◽  
Ambulatory Pulse Pressure

Abstract 4427: Electrocardiographic Left Ventricular Hypertrophy Predicts Long Term Fatal Outcomes in Elderly Hypertensives Despite Diuretic-Based Antihypertensive Treatment: 14-Year Follow-Up of the Systolic Hypertension in the Elderly Program (SHEP)

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Tudor Vagaonescu ◽  
Alan C Wilson ◽  
John B Kostis
Keyword(s):  
Antihypertensive Treatment ◽  
Ventricular Hypertrophy ◽  
Previous History ◽  
The Elderly ◽  
Cardiovascular Death ◽  
Left Ventricular ◽  
All Cause Mortality ◽  
History Of

Background: To assess if diuretic-based antihypertensive treatment improves long term fatal (cardiovascular) outcomes in the elderly with isolated systolic hypertension (ISH) and ECG documented left ventricular hypertrophy (LVH). Methods: Retrospective analysis of the SHEP database of 4,736 patients age ≥60 years and ISH and subsequent vital status ascertainment by matching to the National Death Index. Results: 348 subjects (7.35%) of SHEP participants had ECG documented LVH at baseline. Subjects with LVH had at baseline: higher SBP and pulse pressure (p<0.0001), carotid bruits (13% vs. 7%, p<0.0001) and previous history of myocardial infarction (8% vs. 4%, p=.0008) when compared with participants without LVH. There were no significant differences with regard to age, sex, heart rate, body mass index, smoking and alcohol use, previous history of stroke, diabetes, angina, and assignment to treatment or placebo group. Over 14.3 years (mean) of follow up subjects with baseline LVH experienced significantly more all cause mortality (51% vs. 40%, p<0.0001) and cardiovascular death (24% vs. 19%, p=0.002) than participants without baseline LVH. In the group of participants with LVH at baseline active treatment of hypertension did not decrease all cause mortality (51% vs. 50%, NS) or cardiovascular death (26% vs. 24%, NS). There was no statistically significant interaction between LVH and the assignment to treatment (antihypertensive medication vs. placebo). In a multivariable analysis, the adjusted Cox hazard ratio of developing any fatal outcome in the LVH group was 1.181 (95% CI 1.005–1.387, p=0.043) after adjusting for age, sex, race, history of myocardial infarction, diabetes, alcohol smoking status, education, blood pressure, and assignment to treatment or to placebo group. Conclusion: In the elderly with ISH the presence of LVH documented by ECG increased the risk for long term fatal outcomes despite treatment with diuretic-based antihypertensive therapy. Although active treatment lowered risk in the SHEP study, treated participants with LVH had a higher risk for fatal outcomes than treated subjects without LVH.

scholarly journals Electrocardiographic parameters of left ventricular hypertrophy and prediction of mortality in hemodialysis patients

2021 ◽  
Author(s):  
Matthias C. Braunisch ◽  
Peter Gundel ◽  
Stanislas Werfel ◽  
Christopher C. Mayer ◽  
Axel Bauer ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Risk Prediction ◽  
Cardiovascular Mortality ◽  
Ventricular Hypertrophy ◽  
Cox Regression ◽  
Hemodialysis Patients ◽  
Left Ventricular ◽  
Mortality Prediction ◽  
Prediction Of Mortality

Abstract Background In hemodialysis patients, left ventricular hypertrophy (LVH) contributes to high cardiovascular mortality. We examined cardiovascular mortality prediction by the recently proposed Peguero-Lo Presti voltage since it identifies more patients with electrocardiographic (ECG) LVH than Cornell or Sokolow-Lyon voltages. Methods A total of 308 patients on hemodialysis underwent 24 h ECG recordings. LVH parameters were measured before and after dialysis. The primary endpoint of cardiovascular mortality was recorded during a median 3-year follow up. Risk prediction was assessed by Cox regression, both unadjusted and adjusted for the Charlson Comorbidity Index and the Cardiovascular Mortality Risk Score. Results The Peguero-Lo Presti voltage identified with 21% the most patients with positive LVH criteria. All voltages significantly increased during dialysis. Factors such as ultrafiltration rate, Kt/V, body mass index, sex, and phosphate were the most relevant for these changes. During follow-up, 26 cardiovascular deaths occurred. Post-dialysis Peguero-Lo Presti cut-off as well as the Peguero-Lo Presti and Cornell voltages were independently associated with cardiovascular mortality in unadjusted and adjusted analysis. The Sokolow-Lyon voltage was not significantly associated with mortality. An optimal cut-off for the prediction of cardiovascular mortality was estimated at 1.38 mV for the Peguero-Lo Presti. Conclusions The post-dialysis Peguero-Lo Presti cut-off as well as the Peguero-Lo Presti and Cornell voltages allowed independent risk prediction of cardiovascular mortality in hemodialysis patients. Measuring the ECG LVH parameters after dialysis might allow a standardized interpretation as dialysis-specific factors influence the voltages. Graphical abstract

Abstract 1936: Cornell Product Left Ventricular Hypertrophy In Electrocardiogram Is A Strong Predictor Of Stroke In Community-dwelling Japanese Normotensives

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Joji Ishikawa ◽  
Shizukiyo Ishikawa ◽  
Kazunori Kayaba ◽  
Kazuyuki Shimada ◽  
Kazuomi Kario
Keyword(s):  
General Population ◽  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Cox Regression ◽  
Left Ventricular ◽  
Community Dwelling ◽  
Cox Regression Analysis ◽  
Increased Risk ◽  
Japanese General Population ◽  
Cornell Product

Background : Incidence of stroke is higher than ischemic heart disease in Japanese. Left ventricular hypertrophy (LVH) is associated with an increased risk for stroke among hypertensives. We evaluated the risk of LVH among normotensives (SBP/DBP<120/80 mmHg) subjects. Methods: In a Japanese general population, 10755 subjects who were undertaken electrocardiogram and measured BP at baseline were evaluated Cornell product (CP) and Sokolow-Lyon (SL) voltage as markers of LVH (CP≥2440 mm ms and SL voltage>35 mm). Follow-up was performed for 10 years and incidence of stroke was evaluated. Results: Prevalence of CP-LVH were 2.7% for normotensives, 5.2 % for prehypertensives, 11.0 % for hypertensives, and that of SL-LVH were 8.6%, 11.4%, and 22.5%, respectively. In overall subjects, CP-LVH and SL-LVH were independent predictors of stroke [CP-LVH: hazard risk (HR) 1.65, 95% confidence interval (CI) 1.22–2.25, SL-LVH: HR 1.30, 95%CI 1.02–1.65] after adjustment for confounding factors. In Cox regression analysis in each stage of hypertension, hazard ratios of stroke in subjects with CP-LVH were higher among normotensives (HR 8.28, 95%CI 3.72–18.41) than among prehypertensives (HR 1.56, 95%CI 0.67–3.63) and hypertensives (HR 1.48, 95%CI 1.02–2.13) (Figure ), although that in subjects with SL-LVH were not significant (normotensives: HR 1.54, 95%CI 0.70–3.40, prehypertensives: HR 1.29, 95%CI 0.72–2.32, hypertensives: HR 1.21, 95%CI 0.90–1.62). Conclusion: The ECG-LVH independently predicted future stroke in a Japanese general population. The specificity of the Cornell product-LVH is higher than that of Sokolow-Lyon-LVH especially among normotensive subjects <120/80 mmHg.

Effect of Upper arm Brachial Basilic and Prosthetic Forearm Arteriovenous Fistula on Left Ventricular Hypertrophy

2007 ◽  
Vol 8 (4) ◽  
pp. 296-301 ◽  
Author(s):  
X.H.A. Keuter ◽  
J.P. Kooman ◽  
J. Habets ◽  
F.M. Van Der Sande ◽  
A.G.H. Kessels ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Arteriovenous Fistula ◽  
Ventricular Hypertrophy ◽  
Relative Increase ◽  
Left Ventricular ◽  
Long Term Effects ◽  
Echocardiographic Examination ◽  
Flow Through

Background Creation of an arteriovenous fistula (AVF) may increase left ventricular hypertrophy in the hemodialysis population. Aim of this study was to compare the effects of a brachial-basilic (BB) AVF and the prosthetic brachial-antecubital forearm loop access (PTFE) on cardiac performance. Methods Patients were randomized to receive BB-AVF or prosthetic brachial-antecubital forearm loop access. Before and three months after AVF creation patients underwent an echocardiographic examination. Mann-Whitney U-test was used to compare relative increase between the measured cardiac parameters for the two groups. Results Twenty-seven patients participated in the study. The relative increase in left ventricular parameters was not significantly different between the two groups. Only left ventricular end-diastolic diameter tended to be of significance. Mean blood flow through the brachial artery was 1680±156 and 1450±221 mL/min three months after surgery for the PTFE and the BB-AVF group, respectively. Conclusion After three months of follow-up, changes in cardiac structure were comparable between patients with BB and PTFE AVFs. Also access flow was comparable at this time. In general, the effects of creation of a fistula on LV structure were limited. Longer follow up time may be needed to explore the long term effects of different vascular accesses on cardiac function.

Abstract 1562: Long-term Results (up To 19 Years) Of Balloon Angioplasty Of Coarctation Of The Aorta On Systemic Hypertension And Left Ventricular Hypertrophy.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Walid Hassan ◽  
Mohamed Fawzy ◽  
Jehad Al Buraiki ◽  
Mohamed Al Amri ◽  
Mohamed Shoukri ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Left Ventricular Hypertrophy ◽  
Balloon Angioplasty ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Long Term Results ◽  
Systemic Hypertension ◽  
List Type

Aim : To define the long-term effect of balloon angioplasty (BA) of aortic coarctation (AC) on systemic hypertension and left ventricular hypertrophy (LVH) in adolescent and adult patients. Methods : Follow-up data of 53 patients (mean age 24 ± 9 years) undergoing BA for discrete AC at median interval of 12.5 years (range 5–19 years) including cardiac catheterization, MRI and Echocardiography form the basis of this study. Patients were divided into two groups (A&B) based on whether or not long-term antihypertensive therapy was required. Results : No early or late deaths occurred. Fifty-one patients had baseline hypertension, 49 patients had baseline LVH (92%), BA produced an immediate reduction in peak AC gradient from 66 ± 23 mmHg (95% confidence interval [CI]: 59.5 to 72.7) to 10.8 ± 7 mmHg (95% CI: 8.8 to 12.5) (p< 0.0001). Follow-up catheterization 12 months later revealed a residual gradient of 6.2 ± 6 mmHg (95% CI: 4.4 to 7.9) (p<0.001). The Doppler gradient across coarctation decreased from 59.6 ± 17 to 16 ± 8.4 mmHg at one year and 12.0 ± 6.9 mmHg at last follow-up. Left ventricular mass index (LVMI) decreased significantly in 48 patients (98%) from 132 ± 30.7 (95% CI: 122 to 141.9) to 86 ± 19.9 gram/m 2 (95% CI: 79.5 to 92.5)(p<0.0001). The systolic blood pressure decreased from 165 ± 17 mmHg (95% CI: 159 to 171) to 125 ± 10 mmHg (95% CI: 122 to 131, p<0.001) in 40 patients (group A) and from 184 ± 19 mmHg (95% CI: 169 to 198) to 142 ± 22 mmHg (95% CI: 124 to 156, p<0.001) in 11 patients (group B). The blood pressure had normalized without medication in 40 (78%) of the 51 patients (165 ± 17 mmHg to 115 ± 10 mmHg). Conclusion : Long-term results of BA for discrete AC are excellent and should be considered as first option for treatment of this disease; Regression of LVH (≥ 20% reduction in LVMI) occurred in 98% of patients after BA and only 22% of patients required medications for hypertension.

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