Abstract 17341: Obesity is Associated With Progressive Heart Failure in Hypertrophic Cardiomyopathy

Background: The impact of comorbid disease states and lifestyle on the natural history of patients with hypertrophic cardiomyopathy (HCM) remains unknown. Objective: Evaluate the association of non-HCM comorbidities including obesity, hypertension, diabetes, obstructive sleep apnea, kidney disease, tobacco use, alcohol use, and lung disease with disease progression in a large cohort of HCM patients. Methods: 2269 patients evaluated at the Tufts HCM Institute between 2004 to 2019, ≥ 18 years of age (54 ± 15 years; 1392 male), and followed for an average of 4 ± 3.4 years for disease progression including progressive heart failure (HF) symptoms (from NYHA class I/II to NYHA class III/IV), new-onset atrial fibrillation (AF), or sudden death (SD) event (including appropriate defibrillation for ventricular arrhythmias, resuscitated cardiac arrest, or SD). Results: Of 1376 patients with NYHA class I/II symptoms at initial clinical evaluation, 252 (18%) developed progressive HF symptoms to NYHA class III/IV over follow-up (5%/year). Obesity (BMI ≥ 30) was significantly more prevalent in patients who had progressive HF during follow-up (43%) compared to those who remained without HF (34%, p = 0.014). In contrast, other comorbidities were not significantly associated with progressive HF symptoms (p > 0.10 for all other comorbidities). Of the 1823 patients without AF history at initial clinical visit, 198 (11%) developed new-onset AF over follow-up (3%/year). No comorbidities were significantly associated with new-onset AF in HCM (p > 0.10), although obesity was more common in patients who developed new-onset AF (48%) compared to those who had no AF (41%, p = 0.08). Notably, SD events were not associated with non-HCM comorbidities (p > 0.10 for all comorbidities), and patients with SD events were less likely to have comorbidities than patients without SD events. Conclusions: In adult HCM patients, obesity is associated with progressive symptoms and outcomes supporting weight loss as an important modifier in obese HCM patients to potentially help prevent HCM complications. In contrast, other non-HCM comorbidities do not appear to impact disease course, and SD events are not associated with comorbidities in HCM.

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Abstract 19346: Peak Oxygen Consumption Predicts Outcome in Hypertrophic Cardiomyopathy

Circulation ◽

10.1161/circ.130.suppl_2.19346 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Carla Contaldi ◽

Raffaella Lombardi ◽

Alessandra Giamundo ◽

Sandro Betocchi

Keyword(s):

Heart Failure ◽

Oxygen Consumption ◽

Hypertrophic Cardiomyopathy ◽

Nyha Class ◽

Left Ventricular ◽

Exercise Intolerance ◽

Peak Oxygen Consumption ◽

Class Iii ◽

Asymptomatic Patients

Introduction: Peak oxygen consumption (VO 2 ) has a strong and independent prognostic value in systolic heart failure; in contrast no data support its prognostic role in hypertrophic cardiomyopathy (HCM). Hypothesis: We assess if peak VO 2 is a long-term predictor of outcome in HCM. Methods: We studied 92 HCM patients (40±15 years). Peak VO 2 was expressed as percentage (%) of the predicted value. Follow up was 76±57 months. The primary composite endpoint (CE) was atrial fibrillation, progression to NYHA class III or IV, myotomy-myectomy (MM), heart transplantation (HT) and cardiac death. An ancillary endpoint (HFE) included markers of heart failure (progression to NYHA class III or IV, MM and HT). Results: At baseline, 62% of patients were asymptomatic, 35% NYHA class II and 3% NYHA class III; 26% had left ventricular outflow tract obstruction. During follow up, 30 patients met CE with 43 events. By multivariate Cox survival analysis, we analyzed 2 models, using the CE, and in turn HFE. For CE, maximal left atrial diameter (LAD) (HR: 1.12; 95% CI: 1.04 to 1.22), maximal wall thickness (MWT) (HR: 0.14; 95% CI: 1.04 to 1.23) and % predicted peak VO 2 (HR: -0.03; 95% CI: 0.95 to 0.99) independently predicted outcome (overall, p<0.0001). For HFE, maximal LAD (HR:0.31; 95% CI: 1.09 to 1.70), MWT (HR: 0.35; 95% CI: 1.08 to 1.84) and % predicted peak VO 2 (HR: -0.06; 95% CI: 0.89 to 0.98) independently predicted outcome (overall, p<0.0001). Only 19% of mildly symptomatic or asymptomatic patients with % predicted peak VO 2 >80% had events, as opposed to 53% of them with % predicted peak VO 2 < 55% (p= 0.04). Event-free survival for both endpoints was significantly lower in patients with % predicted peak VO 2 < 55% as compared to those with it between 55 and 80 and >80% , Figure. Conclusion: In mildly or asymptomatic patients severe exercise intolerance may precede clinical deterioration. In HCM, peak VO 2 provides excellent risk stratification with a high event rate in patients with % predicted value <55%.

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The Impact of Advance Directive Perspectives on the Completion of Life-Sustaining Treatment Decisions in Patients with Heart Failure: A Prospective Study

Journal of Clinical Medicine ◽

10.3390/jcm10245962 ◽

2021 ◽

Vol 10 (24) ◽

pp. 5962

Author(s):

JinShil Kim ◽

Seongkum Heo ◽

Bong Roung Kim ◽

Soon Yong Suh ◽

Jae Lan Shim ◽

...

Keyword(s):

Higher Education ◽

Heart Failure ◽

Nyha Class ◽

Heart Association ◽

Advanced Age ◽

Class Iii ◽

Modifiable Factors ◽

Life Sustaining Treatment ◽

The Impact

Evidence for non-modifiable and modifiable factors associated with the utilization of advance directives (ADs) in heart failure (HF) is lacking. The purpose of this study was to examine baseline-to-3-month changes in knowledge, attitudes, and benefits/barriers regarding ADs and their impact on the completion of life-sustaining treatment (LST) decisions at 3-month follow-up among patients with HF. Prospective, descriptive data on AD knowledge, attitudes, and benefits/barriers and LSTs were obtained at baseline and 3-month follow-up after outpatient visits. Of 64 patients (age, 68.6 years; male, 60.9%; New York Heart Association (NYHA) classes I/II, 70.3%), 53.1% at baseline and 43.8% at 3-month follow-up completed LST decisions. Advanced age (odds ratio (OR) = 0.91, p = 0.012) was associated with less likelihood of the completion of LST decisions at 3-month follow-up, while higher education (OR = 1.19, p = 0.025) and NYHA class III/IV (OR = 4.81, p = 0.049) were associated with more likelihood. In conclusion, advanced age predicted less likelihood of LST decisions at 3 months, while higher education and more functional impairment predicted more likelihood. These results imply that early AD discussion seems feasible in mild symptomatic HF patients with poor knowledge about ADs, considering the non-modifiable and modifiable factors.

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Machine Learning for Predicting Heart Failure Progression in Hypertrophic Cardiomyopathy

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.647857 ◽

2021 ◽

Vol 8 ◽

Author(s):

Ahmed S. Fahmy ◽

Ethan J. Rowin ◽

Warren J. Manning ◽

Martin S. Maron ◽

Reza Nezafat

Keyword(s):

Machine Learning ◽

Heart Failure ◽

Hypertrophic Cardiomyopathy ◽

High Risk ◽

Nyha Class ◽

Functional Class ◽

Class I ◽

Study Cohort ◽

Correct Identification ◽

Class Iii

Background: Development of advanced heart failure (HF) symptoms is the most common adverse pathway in hypertrophic cardiomyopathy (HCM) patients. Currently, there is a limited ability to identify HCM patients at risk of HF.Objectives: In this study, we present a machine learning (ML)-based model to identify individual HCM patients who are at high risk of developing advanced HF symptoms.Methods: From a consecutive cohort of HCM patients evaluated at the Tufts HCM Institute from 2001 to 2018, we extracted a set of 64 potential risk factors measured at baseline. Only patients with New York Heart Association (NYHA) functional class I/II and LV ejection fraction (LVEF) by echocardiography >35% were included. The study cohort (n = 1,427 patients) was split into three disjoint subsets: development (50%), model selection (10%), and independent validation (40%). The least absolute shrinkage and selection operator was used to select the most influential clinical variables. An ensemble of ML classifiers, including logistic regression, was used to identify patients with high risk of developing a HF outcome. Study outcomes were defined as progression to NYHA class III/IV, drop in LVEF below 35%, septal reduction procedure, and/or heart transplantation.Results: During a mean follow-up of 4.7 ± 3.7 years, advanced HF occurred in 283 (20% out of 1,427) patients. The model features included patients' sex, NYHA class (I or II), HCM type (i.e., obstructive or not), LV wall thickness, LVEF, presence of HF symptoms (e.g., dyspnea, presyncope), comorbidities (atrial fibrillation, hypertension, mitral regurgitation, and systolic anterior motion), and type of cardiac medications. The developed risk stratification model showed strong differentiation power to identify patients at advanced HF risk in the testing dataset (c-statistics = 0.81; 95% confidence interval [CI]: 0.76, 0.86). The model allowed correct identification of high-risk patients with accuracy 74% (CI: 0.70, 0.78), sensitivity 80% (CI: 0.77, 0.83), and specificity 72% (CI: 0.68, 0.76). The model performance was comparable among different sex and age groups.Conclusions: A 5-year risk prediction of progressive HF in HCM patients can be accurately estimated using ML analysis of patients' clinical and imaging parameters. A set of 17 clinical and imaging variables were identified as the most important predictors of progressive HF in HCM.

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Abstract 14647: Stress Echocardiography Predicts Heart Failure Progression and Alters Management Strategies in Patients with Hypertrophic Cardiomyopathy

Circulation ◽

10.1161/circ.130.suppl_2.14647 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Ethan J Rowin ◽

Barry J Maron ◽

Iacopo Olivotto ◽

Susan A Casey ◽

Anna Arretini ◽

...

Keyword(s):

Heart Failure ◽

Nyha Class ◽

Management Strategies ◽

Left Ventricular ◽

Advanced Heart Failure ◽

Outflow Tract ◽

Class I ◽

Class Iii ◽

Outflow Obstruction ◽

Heart Failure Progression

Background: One-third of HCM patients without left ventricular outflow tract obstruction under resting conditions have the propensity to develop an outflow gradient with physiologic exercise. However, the natural history and management implications of exercise-induced (i.e., provocable) obstruction is unresolved. Methods: We prospectively studied 533 consecutive HCM patients without outflow obstruction at rest (<30mmHg) who underwent a symptom limiting stress (exercise) echocardiogram to assess development of outflow obstruction following physiologic provocation and followed for 6.5 ± 2.0 years. Of the 533 patients, obstruction ≥ 30 mmHg was present following exercise in 262 patients (49%; provocable obstruction), and was absent both at rest and with exercise in 271 (51%; nonobstructive). Results: Over the follow-up period, 43 out of 220 (20%) HCM patients with provocable obstruction and baseline NYHA class I/II symptoms developed progressive limiting heart failure symptoms to class III/IV, compared to 24 of 249 (10%) nonobstructive patients. Rate of heart failure progression was significantly greater in patients with provocable obstruction vs. nonobstructive patients (3.1%/year vs. 1.5%/year; RR=2.0, 95% CI of 1.3-3.2; p=0.003). However, the vast majority of patients with provocable obstruction who developed advanced heart failure symptoms achieved substantial improvement in symptoms to class I / II following relief of obstruction with invasive septal reduction therapy (n=30/32; 94%). In comparison, the majority of nonobstructive patients who developed advanced heart failure remained in class III/IV (16/24;67%), including 10 (42%) currently listed for heart transplant. Conclusions: Stress (exercise) echocardiogram identifies physiological provocable outflow tract obstruction in HCM, and is a predictor of future risk for progressive heart failure (3.1%/year), in patients who become candidates for invasive septal reduction therapy. Therefore, exercise echocardiography should be considered in all HCM patients without obstruction under resting conditions.

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Abstract 901: Effects of Bucindolol on Cardiovascular Mortality and Morbidity are Determined by the Beta-1 389 Arg/Gly Receptor Polymorphism

Circulation ◽

10.1161/circ.116.suppl_16.ii_176-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Michel White ◽

Peter Carson ◽

Inder S Anand ◽

Stephen S Gottlieb ◽

JoAnn Lindenfeld ◽

...

Keyword(s):

Heart Failure ◽

Amino Acid ◽

Cardiovascular Mortality ◽

Nyha Class ◽

Total Mortality ◽

Chronic Administration ◽

Amino Acid Position ◽

Class Iii ◽

Mortality And Morbidity ◽

The Impact

Introduction: Bucindolol is a nonselective beta-adrenergic blocker with potent sympatholytic properties. The Beta-blocker Evaluation of Survival Trial (BEST) reported that the administration of bucindolol resulted in a nonsignificant decrease in total mortality (HR = 0.89 (0.78, 1.02), unadjusted p=0.10) in patients with advanced, NYHA Class III-IV heart failure (HF). Recent observations from that trial also reported that the amino acid arginine (Arg/Arg) or glycine (any Gly) in position 389 of the beta-1 receptor plays a significant role on the clinical response to bucindolol. The impact of bucindolol on cardiovascular mortality and morbidity (cardiovascular hospitalizations) has been incompletely investigated, because hospitalizations had been evaluated from case report forms (CRFs) only, and never adjudicated by the endpoints committee (EPC). Methods: The BEST data base consists of 2708 patients with a mean follow-up of 2.0 years. Cardiovascular (CV) mortality and hospitalizations have now been evaluated by EPC, which further subclassified total hospitalizations into cardiovascular (CV) and those due to worsening heart failure (HF). The impacts of Arg or Gly encoded at amino acid position 389 on endpoints were further investigated in the 1040 patient substudy. Results: Time to event results for adjudicated CV endpoints are presented below. Conclusions: Chronic administration of bucindolol results in a significant reduction in cardiovascular hospitalizations and mortality. Effects on either are strikingly beta-1 389 Arg/Gly specific, with the higher functioning, Arg/Arg version of the receptor associated with large treatment effects and Gly carriers exhibiting little or no evidence of efficacy. Genetic targeting of the β 1 -ΑR 389 polymorphism may improve the clinical responses to bucindolol for CV mortality and morbidity.

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Outcome of Albumin Infusion in Heart Failure Patients

University Heart Journal ◽

10.3329/uhj.v15i2.42646 ◽

2019 ◽

Vol 15 (2) ◽

pp. 47-53

Author(s):

Ashaduzzaman Talukder ◽

Mohamed Mausool Siraj ◽

Md Noornabi Khondokar ◽

SM Ahsan Habib ◽

Md Abu Salim ◽

...

Keyword(s):

Heart Failure ◽

Serum Albumin ◽

Nyha Class ◽

Class Ii ◽

Class I ◽

Class Iii ◽

Albumin Infusion ◽

Group A ◽

Group B ◽

Class Iv

Background: Heart Failure (HF) is a major public health burden worldwide. Approximately 5 million Americans, 0.4–2% of the general European population and over 23 million people worldwide are living with heart failure. Like few other chronic disease, low serum albumin is common in patients with heart failure (HF). However, very few studies evaluated the outcome of albumin infusion in different stages of HF. Therefore, the objective of this study is to assess the outcome of albumin infusion in heart failure patients. Methods: It was a cross-sectional study. A total of 50 cases of chronic heart failure with reduced ejection fraction and NYHA class III or IV with serum albumin level <2.5g/dl who were admitted in CCUwere selected by purposive sampling, from September 2017 to August 2018. 100ml of 20% albumin was infused and serum albumin was measured after 3 days. Then the patients were divided into two groups, Patients who failed to attain serum albumin of 3g/dl(Group A) or Patients who attained serum albumin of ≥3g/dl (Group B). Analysis and comparison for symptomatic improvement of heart failure by NHYA classification and LVEF was done at 10th day after infusion between group A and B. Result: Among the 50 patients, mean age of patients was 53.64 ± 13.44 years (age range: 26-84 years) with a male-female ratio of 3:2 (60%-male vs 40%- female). Majority patients were previously re-admitted at least two times (40%), 28% were re-admitted once, 16% were re-admitted three times and 4% were re-admitted for four times. Of all, 56% patients presented NYHA class IV and AHA stage D heart failure (56%) and 44% patients presented with NYHA class III and AHA stage C. At day 10 follow up following albumin infusion, overall frequency of following ten days of albumin therapy, in group B, 8 patients (72.7%) among Class III improved to Class I and 3 patients (27.3%) improved to class II. Also, 7 patients (50%), 5 patients (35.7%) and 2 patients (14.3%) among class IV improved to respectively class I, class II and class III. In group A, 3 patients (27.3%) among class III improve to class II and 8 patients (72.7%) remain in class III. Also, 2 patients (14.3%), 5 Patients (35.7%) and 7 patients (50%) among class IV improve to respectively class I, class II and class III. Moreover, statistically significant improvement was noted in ejection fraction of patents irrespective of initial class of heart failure (p<0.001) in group B patients compare to group A (p<0.09). Conclusion: In this study, the improvement of heart failure was more in patients who attained albumin level of ≥3g/dl.Therefore, in can be concluded that albumin infusion improves both subjective and objective improvement of patients with heart failure. University Heart Journal Vol. 15, No. 2, Jul 2019; 47-53

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Impact of exercise capacity on the long-term incidence of atrial arrhythmias in heart failure

Scientific Reports ◽

10.1038/s41598-021-98172-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Tetsuri Sakai ◽

Atsuhiko Yagishita ◽

Masahiro Morise ◽

Susumu Sakama ◽

Takeshi Ijichi ◽

...

Keyword(s):

Heart Failure ◽

Ventricular Arrhythmias ◽

Maximal Exercise ◽

Peak Exercise ◽

Atrial Arrhythmias ◽

Patients With Heart Failure ◽

The Impact ◽

New Onset

AbstractWe sought to demonstrate the impact of improved peak exercise oxygen consumption (V̇O2) during maximal exercise testing after cardiac rehabilitation (CR) on the incidence of arrhythmias in patients with heart failure (HF). The present study comprised of 220 patients with HF, and peak V̇O2 was examined at 2 and 5 months after CR. Of the 220 patients, 110 (50%) had a low peak V̇O2 of < 14 mL/min/kg at 2 months. The peak V̇O2 improved in 86 of these 110 (78%) patients at 5 months after CR. During a median follow-up of 6 years, the patients with improvement in peak V̇O2, compared to those without peak V̇O2 improvement, had a lower rate of mortality (4% vs. 29%, log-rank, P < 0.001) and HF hospitalization (6 vs. 17%, log-rank, P = 0.044) and a lower incidence of new-onset atrial arrhythmias (9 vs. 27%, log-rank, P = 0.013), with no difference in the incidence of ventricular arrhythmias between groups (1 vs. 4%, log-rank, P = 0.309). The majority of deaths in the patients without an improved peak V̇O2 were because of cardiovascular events (73%), particularly progressive HF (55%). Early detection and management of atrial arrhythmias may improve outcomes in patients without peak V̇O2 improvement after CR.

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Cardiovascular magnetic resonance predictors of heart failure in hypertrophic cardiomyopathy: the role of myocardial replacement fibrosis and the microcirculation

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/s12968-021-00720-9 ◽

2021 ◽

Vol 23 (1) ◽

Author(s):

Claire E. Raphael ◽

Frances Mitchell ◽

Gajen Sunthar Kanaganayagam ◽

Alphonsus C. Liew ◽

Elisa Di Pietro ◽

...

Keyword(s):

Heart Failure ◽

Cardiovascular Magnetic Resonance ◽

Hypertrophic Cardiomyopathy ◽

Magnetic Resonance ◽

Mitral Regurgitation ◽

Cardiac Transplantation ◽

Nyha Class ◽

Composite Endpoint ◽

Class Iii

Abstract Introduction Heart failure (HF) in hypertrophic cardiomyopathy (HCM) is associated with high morbidity and mortality. Predictors of HF, in particular the role of myocardial fibrosis and microvascular ischemia remain unclear. We assessed the predictive value of cardiovascular magnetic resonance (CMR) for development of HF in HCM in an observational cohort study. Methods Serial patients with HCM underwent CMR, including adenosine first-pass perfusion, left atrial (LA) and left ventricular (LV) volumes indexed to body surface area (i) and late gadolinium enhancement (%LGE- as a % of total myocardial mass). We used a composite endpoint of HF death, cardiac transplantation, and progression to NYHA class III/IV. Results A total of 543 patients with HCM underwent CMR, of whom 94 met the composite endpoint at baseline. The remaining 449 patients were followed for a median of 5.6 years. Thirty nine patients (8.7%) reached the composite endpoint of HF death (n = 7), cardiac transplantation (n = 2) and progression to NYHA class III/IV (n = 20). The annual incidence of HF was 2.0 per 100 person-years, 95% CI (1.6–2.6). Age, previous non-sustained ventricular tachycardia, LV end-systolic volume indexed to body surface area (LVESVI), LA volume index ; LV ejection fraction, %LGE and presence of mitral regurgitation were significant univariable predictors of HF, with LVESVI (Hazard ratio (HR) 1.44, 95% confidence interval (95% CI) 1.16–1.78, p = 0.001), %LGE per 10% (HR 1.44, 95%CI 1.14–1.82, p = 0.002) age (HR 1.37, 95% CI 1.06–1.77, p = 0.02) and mitral regurgitation (HR 2.6, p = 0.02) remaining independently predictive on multivariable analysis. The presence or extent of inducible perfusion defect assessed using a visual score did not predict outcome (p = 0.16, p = 0.27 respectively). Discussion The annual incidence of HF in a contemporary ambulatory HCM population undergoing CMR is low. Myocardial fibrosis and LVESVI are strongly predictive of future HF, however CMR visual assessment of myocardial perfusion was not.

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Prognostic value of global longitudinal strain versus mitral annular plane systolic excursion in patients with ischemic heart failure

European Heart Journal ◽

10.1093/ehjci/ehaa946.1011 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

D Liu ◽

C Wagner ◽

K Hu ◽

B Lengenfelder ◽

G Ertl ◽

...

Keyword(s):

Heart Failure ◽

Longitudinal Strain ◽

Nyha Class ◽

Global Longitudinal Strain ◽

Ischemic Heart ◽

Ischemic Heart Failure ◽

Class Iii ◽

Heart Failure Patients ◽

All Cause Mortality

Abstract Background Mitral annular plane systolic excursion (MAPSE) derived from M-mode echocardiography is a classical risk factor of clinical outcome in heart failure patients. Two-dimensional-echocardiography (2DE) derived global longitudinal strain (GLS) is also related to outcome in patients with heart failure. This study aimed to compare the prognostic performance between GLS and MAPSE in ischemic heart failure patients with reduced ejection fraction. We sought to test the hypothesis that GLS might be superior to MAPSE as a risk stratification marker in these patients. Methods In total, 1277 ischemic heart failure patients with reduced left ventricular ejection fraction (LVEF<50%), referred to our department between 2009 and 2017, were included in this retrospective study. Offline standard echocardiographic measurements including MAPSE and GLS were performed. Average MAPSE of septal and lateral walls (MAPSE_Avg) was calculated. GLS was derived from the segmental averaging (18-segment) of the three apical views. All patients completed at least one-year clinical follow-up by telephone interview or clinical visit. The primary endpoint was defined as all-cause mortality or heart transplantation (HTx). Results At baseline visit, mean age was 70±11 years and 79.6% were men. NYHA class III-IV were identified in 33.5% of patients. Coronary artery disease was confirmed by coronary angiography. 63.0% patients had a history of myocardial infarction, 32.1% underwent PCI, and 16.8% underwent coronary artery bypass grafting. Over a median follow-up period of 26 (14–39) months, 369 (28.9%) patients died and 5 (0.4%) underwent HTx. Median LVEF was 39% (32–45%), and there were 48.0% patients with LVEF between 40–49%, 32.3% patients with LVEF between 30–49% and 19.7% patients with LVEF <30%. MAPSE_Avg was 8.0 (6.5–10.0) mm and median GLS was −9.9% (−7.7 to −12.3%). Clinical covariates significantly associated with all-cause mortality in this cohort included age (HR=1.048), NYHA class III-IV (HR=1.800), AF (HR=1.567), diabetes (HR=1.262), dyslipidemia (HR=0.657), hyperuricemia (HR=1.861), peripheral vascular disease (HR 1.858), chronic respiratory diseases (HR=1.680), and renal dysfunction (HR=2.705). Multivariable Cox regression analysis showed that reduced MAPSE_Avg (<7mm, HR=1.431, 95% CI 1.146–1.786) and reduced GLS (<8.3%, HR=1.519, 95% CI 1.230–1.875) were independent predictors of all-cause mortality after adjustment of above-mentioned clinical confounders. ROC curves demonstrated that the predictive performance of all-cause mortality among LVEF, MAPSE_Avg, and GLS were similar (AUC=0.608, 0.601, and 0.616, respectively, all P<0.001). Conclusions Both 2DE-guided GLS and MAPSE could provide additional prognostic information in ischemic heart failure patients with reduced LVEF. Prognostic performance of GLS, MAPSE, and LVEF is similar in ischemic heart failure patients with reduced LVEF. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): The German Federal Ministry of Education and Research

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Prognostic impact of atrial fibrillation in patients with hypertrophic cardiomyopathy in a community-based Japanese cohort: results from Kochi RYOMA study

European Heart Journal ◽

10.1093/ehjci/ehaa946.2082 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

T Kubo ◽

K Sugiura ◽

Y Ochi ◽

A Takahashi ◽

Y Baba ◽

...

Keyword(s):

Atrial Fibrillation ◽

Hypertrophic Cardiomyopathy ◽

Adverse Events ◽

Left Ventricular ◽

Disease Stage ◽

Prognostic Impact ◽

Class Iii ◽

Community Based ◽

New Onset

Abstract Background The prognostic impact of atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM) is not fully elucidated. Purpose The aim of this study was to examine the prevalence and prognostic impact of AF in a prospectively assembled community-based HCM patient cohort in an aged Japanese community. Methods In 2004, we established a cardiomyopathy registration network in Kochi Prefecture, Japan, consisting of 9 hospitals, and finally 293 patients with HCM were followed. Results The ages at registration and at diagnosis were 63±14 and 56±16 years, respectively, and 197 patients (67%) were men. 86 patients (29%) showed AF. During follow-up period of 6.1±3.2 years, 44 patients died. In those patients, HCM-related deaths occurred in 23 patients with an annual mortality rate of 1.3%. Regarding HCM-related adverse events including HCM-related deaths, appropriate ICD discharge, heart failure admission and hospitalization for embolic events, a total of 77 cardiovascular events in 70 patients occurred. Multivariate analysis revealed that presence of AF, left ventricular (LV) outflow obstruction, NYHA functional class III, and lower LV fractional shortening at registration were significant predictors of these adverse events. During the follow-up period, additional 31 patients (11%) developed new-onset AF. Importantly, the incidence of HCM-related adverse events was significantly higher in patients with new AF observed from its onset compared with those with AF at registration (log-rank p=0.029) (Figure 1). Conclusions In an unselected HCM registry in an aged Japanese community, presence of AF, particularly new-onset AF, was associated with unfavorable clinical outcomes. AF is not just a marker of the disease stage but an important trigger of HCM-related adverse events. Figure 1 Funding Acknowledgement Type of funding source: None

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