Comparison of Outcomes in Patients With Nonobstructive, Labile-Obstructive, and Chronically Obstructive Hypertrophic Cardiomyopathy

Iraklis Pozios, Celia Corona Villalobos, Lars L. Sorensen, Paco E. Bravo, Marco Canepa, Chiara Pisanello, Aurelio Pinheiro, Veronica L. Dimaano, Hongchang Luo, Zeina Dardari, Xun Zhou, Ihab R Kamel, Stefan Zimmerman, David A. Bluemke, M. Roselle Abraham, Theodore P. Abraham

Research output: Contribution to journalArticle

Abstract

Patients with nonobstructive hypertrophic cardiomyopathy (HC) are considered low risk, generally not requiring aggressive intervention. However, nonobstructive and labile-obstructive HC have been traditionally classified together, and it is unknown if these 2 subgroups have distinct risk profiles. We compared cardiovascular outcomes in 293 patients HC (96 nonobstructive, 114 labile-obstructive, and 83 obstructive) referred for exercise echocardiography and magnetic resonance imaging and followed for 3.3 ± 3.6 years. A subgroup (34 nonobstructive, 28 labile-obstructive, 21 obstructive) underwent positron emission tomography. The mean number of sudden cardiac death risk factors was similar among groups (nonobstructive: 1.4 vs labile-obstructive: 1.2 vs obstructive: 1.4 risk factors, p = 0.2). Prevalence of late gadolinium enhancement (LGE) was similar across groups but more non-obstructive patients had late gadolinium enhancement ≥20% of myocardial mass (23 [30%] vs 19 [18%] labile-obstructive and 8 [11%] obstructive, p = 0.01]. Fewer labile-obstructive patients had regional positron emission tomography perfusion abnormalities (12 [46%] vs nonobstructive 30 [81%] and obstructive 17 [85%], p = 0.003]. During follow-up, 60 events were recorded (36 ventricular tachycardia/ventricular fibrillation, including 30 defibrillator discharges, 12 heart failure worsening, and 2 deaths). Nonobstructive patients were at greater risk of VT/VF at follow-up, compared to labile obstructive (hazed ratio 0.18, 95% confidence interval 0.04 to 0.84, p = 0.03) and the risk persisted after adjusting for age, gender, syncope, family history of sudden cardiac death, abnormal blood pressure response, and septum ≥3 cm (p = 0.04). Appropriate defibrillator discharges were more frequent in nonobstructive (8 [18%]) compared to labile-obstructive (0 [0%], p = 0.02) patients. In conclusion, nonobstructive hemodynamics is associated with more pronounced fibrosis and ischemia than labile-obstructive and is an independent predictor of VT/VF in HC.

Original languageEnglish (US)
Article number21246
Pages (from-to)938-944
Number of pages7
JournalThe American Journal of Cardiology
Volume116
Issue number6
DOIs
StatePublished - Sep 15 2015

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Hypertrophic Cardiomyopathy
Defibrillators
Sudden Cardiac Death
Gadolinium
Positron-Emission Tomography
Syncope
Ventricular Fibrillation
Ventricular Tachycardia
Echocardiography
Fibrosis
Ischemia
Heart Failure
Perfusion
Hemodynamics
Magnetic Resonance Imaging
Confidence Intervals
Exercise
Blood Pressure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Comparison of Outcomes in Patients With Nonobstructive, Labile-Obstructive, and Chronically Obstructive Hypertrophic Cardiomyopathy. / Pozios, Iraklis; Corona Villalobos, Celia; Sorensen, Lars L.; Bravo, Paco E.; Canepa, Marco; Pisanello, Chiara; Pinheiro, Aurelio; Dimaano, Veronica L.; Luo, Hongchang; Dardari, Zeina; Zhou, Xun; Kamel, Ihab R; Zimmerman, Stefan; Bluemke, David A.; Abraham, M. Roselle; Abraham, Theodore P.

In: The American Journal of Cardiology, Vol. 116, No. 6, 21246, 15.09.2015, p. 938-944.

Research output: Contribution to journalArticle

Pozios, I, Corona Villalobos, C, Sorensen, LL, Bravo, PE, Canepa, M, Pisanello, C, Pinheiro, A, Dimaano, VL, Luo, H, Dardari, Z, Zhou, X, Kamel, IR, Zimmerman, S, Bluemke, DA, Abraham, MR & Abraham, TP 2015, 'Comparison of Outcomes in Patients With Nonobstructive, Labile-Obstructive, and Chronically Obstructive Hypertrophic Cardiomyopathy', The American Journal of Cardiology, vol. 116, no. 6, 21246, pp. 938-944. https://doi.org/10.1016/j.amjcard.2015.06.018
Pozios, Iraklis ; Corona Villalobos, Celia ; Sorensen, Lars L. ; Bravo, Paco E. ; Canepa, Marco ; Pisanello, Chiara ; Pinheiro, Aurelio ; Dimaano, Veronica L. ; Luo, Hongchang ; Dardari, Zeina ; Zhou, Xun ; Kamel, Ihab R ; Zimmerman, Stefan ; Bluemke, David A. ; Abraham, M. Roselle ; Abraham, Theodore P. / Comparison of Outcomes in Patients With Nonobstructive, Labile-Obstructive, and Chronically Obstructive Hypertrophic Cardiomyopathy. In: The American Journal of Cardiology. 2015 ; Vol. 116, No. 6. pp. 938-944.
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AU - Corona Villalobos, Celia

AU - Sorensen, Lars L.

AU - Bravo, Paco E.

AU - Canepa, Marco

AU - Pisanello, Chiara

AU - Pinheiro, Aurelio

AU - Dimaano, Veronica L.

AU - Luo, Hongchang

AU - Dardari, Zeina

AU - Zhou, Xun

AU - Kamel, Ihab R

AU - Zimmerman, Stefan

AU - Bluemke, David A.

AU - Abraham, M. Roselle

AU - Abraham, Theodore P.

PY - 2015/9/15

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N2 - Patients with nonobstructive hypertrophic cardiomyopathy (HC) are considered low risk, generally not requiring aggressive intervention. However, nonobstructive and labile-obstructive HC have been traditionally classified together, and it is unknown if these 2 subgroups have distinct risk profiles. We compared cardiovascular outcomes in 293 patients HC (96 nonobstructive, 114 labile-obstructive, and 83 obstructive) referred for exercise echocardiography and magnetic resonance imaging and followed for 3.3 ± 3.6 years. A subgroup (34 nonobstructive, 28 labile-obstructive, 21 obstructive) underwent positron emission tomography. The mean number of sudden cardiac death risk factors was similar among groups (nonobstructive: 1.4 vs labile-obstructive: 1.2 vs obstructive: 1.4 risk factors, p = 0.2). Prevalence of late gadolinium enhancement (LGE) was similar across groups but more non-obstructive patients had late gadolinium enhancement ≥20% of myocardial mass (23 [30%] vs 19 [18%] labile-obstructive and 8 [11%] obstructive, p = 0.01]. Fewer labile-obstructive patients had regional positron emission tomography perfusion abnormalities (12 [46%] vs nonobstructive 30 [81%] and obstructive 17 [85%], p = 0.003]. During follow-up, 60 events were recorded (36 ventricular tachycardia/ventricular fibrillation, including 30 defibrillator discharges, 12 heart failure worsening, and 2 deaths). Nonobstructive patients were at greater risk of VT/VF at follow-up, compared to labile obstructive (hazed ratio 0.18, 95% confidence interval 0.04 to 0.84, p = 0.03) and the risk persisted after adjusting for age, gender, syncope, family history of sudden cardiac death, abnormal blood pressure response, and septum ≥3 cm (p = 0.04). Appropriate defibrillator discharges were more frequent in nonobstructive (8 [18%]) compared to labile-obstructive (0 [0%], p = 0.02) patients. In conclusion, nonobstructive hemodynamics is associated with more pronounced fibrosis and ischemia than labile-obstructive and is an independent predictor of VT/VF in HC.

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