Impact of peak provoked left ventricular outflow tract gradients on clinical outcomes in hypertrophic cardiomyopathy

Dai Yin Lu, Bereketeab Hailesealassie, Ioannis Ventoulis, Hongyun Liu, Hsin Yueh Liang, Alexandra Nowbar, Iraklis Pozios, Marco Canepa, Kenneth Cresswell, Hong Chang Luo, M. Roselle Abraham, Theodore P. Abraham

Research output: Research - peer-reviewArticle

Abstract

Background Hypertrophic cardiomyopathy (HCM) is traditionally classified based on a left ventricular outflow tract (LVOT) pressure gradient of 30 mmHg at rest or with provocation. There are no data on whether 30 mmHg is the most informative cut-off value and whether provoked gradients offer any information regarding outcomes. Methods Resting and provoked peak LVOT pressure gradients were measured by Doppler echocardiography in patients fulfilling guidelines criteria for HCM. A composite clinical outcome including new onset atrial fibrillation, ventricular tachycardia/fibrillation, heart failure, transplantation, and death was examined over a median follow-up period of 2.1 years. Results Among 536 patients, 131 patients had resting LVOT gradients greater than 30 mmHg. Subjects with higher resting gradients were older with more cardiovascular events. For provoked gradients, a bi-modal risk distribution was found. Patients with provoked gradients > 90 mmHg (HR 3.92, 95% CI 1.97–7.79) or < 30 mmHg (HR 2.15, 95% CI 1.08–4.29) have more events compared to those with gradients between 30 and 89 mmHg in multivariable analysis. The introduction of two cut-off points for provoked gradients allowed HCM to be reclassified into four groups: patients with “benign” latent HCM (provoked gradient 30–89 mmHg) had the best prognosis, whereas those with persistent obstructive HCM had the worst outcome. Conclusions Provoked LVOT pressure gradients offer additional information regarding clinical outcomes in HCM. Applying cut-off points at 30 and 90 mmHg to provoked LVOT pressure gradients further classifies HCM patients into low-, intermediate- and high-risk groups.

LanguageEnglish (US)
Pages290-295
Number of pages6
JournalInternational Journal of Cardiology
Volume243
DOIs
StatePublished - Sep 15 2017

Fingerprint

Hypertrophic Cardiomyopathy
Pressure
Doppler Echocardiography
Ventricular Fibrillation
Heart Transplantation
Ventricular Tachycardia
Atrial Fibrillation
Heart Failure
Guidelines

Keywords

  • Hypertrophic cardiomyopathy
  • Left ventricle outflow tract obstruction
  • Stress echocardiography
  • Survival

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine

Cite this

Lu, D. Y., Hailesealassie, B., Ventoulis, I., Liu, H., Liang, H. Y., Nowbar, A., ... Abraham, T. P. (2017). Impact of peak provoked left ventricular outflow tract gradients on clinical outcomes in hypertrophic cardiomyopathy. International Journal of Cardiology, 243, 290-295. DOI: 10.1016/j.ijcard.2017.04.039

Impact of peak provoked left ventricular outflow tract gradients on clinical outcomes in hypertrophic cardiomyopathy. / Lu, Dai Yin; Hailesealassie, Bereketeab; Ventoulis, Ioannis; Liu, Hongyun; Liang, Hsin Yueh; Nowbar, Alexandra; Pozios, Iraklis; Canepa, Marco; Cresswell, Kenneth; Luo, Hong Chang; Abraham, M. Roselle; Abraham, Theodore P.

In: International Journal of Cardiology, Vol. 243, 15.09.2017, p. 290-295.

Research output: Research - peer-reviewArticle

Lu, DY, Hailesealassie, B, Ventoulis, I, Liu, H, Liang, HY, Nowbar, A, Pozios, I, Canepa, M, Cresswell, K, Luo, HC, Abraham, MR & Abraham, TP 2017, 'Impact of peak provoked left ventricular outflow tract gradients on clinical outcomes in hypertrophic cardiomyopathy' International Journal of Cardiology, vol 243, pp. 290-295. DOI: 10.1016/j.ijcard.2017.04.039
Lu DY, Hailesealassie B, Ventoulis I, Liu H, Liang HY, Nowbar A et al. Impact of peak provoked left ventricular outflow tract gradients on clinical outcomes in hypertrophic cardiomyopathy. International Journal of Cardiology. 2017 Sep 15;243:290-295. Available from, DOI: 10.1016/j.ijcard.2017.04.039
Lu, Dai Yin ; Hailesealassie, Bereketeab ; Ventoulis, Ioannis ; Liu, Hongyun ; Liang, Hsin Yueh ; Nowbar, Alexandra ; Pozios, Iraklis ; Canepa, Marco ; Cresswell, Kenneth ; Luo, Hong Chang ; Abraham, M. Roselle ; Abraham, Theodore P./ Impact of peak provoked left ventricular outflow tract gradients on clinical outcomes in hypertrophic cardiomyopathy. In: International Journal of Cardiology. 2017 ; Vol. 243. pp. 290-295
@article{df5de82341e04f53ba32d425941bee0e,
title = "Impact of peak provoked left ventricular outflow tract gradients on clinical outcomes in hypertrophic cardiomyopathy",
abstract = "Background Hypertrophic cardiomyopathy (HCM) is traditionally classified based on a left ventricular outflow tract (LVOT) pressure gradient of 30 mmHg at rest or with provocation. There are no data on whether 30 mmHg is the most informative cut-off value and whether provoked gradients offer any information regarding outcomes. Methods Resting and provoked peak LVOT pressure gradients were measured by Doppler echocardiography in patients fulfilling guidelines criteria for HCM. A composite clinical outcome including new onset atrial fibrillation, ventricular tachycardia/fibrillation, heart failure, transplantation, and death was examined over a median follow-up period of 2.1 years. Results Among 536 patients, 131 patients had resting LVOT gradients greater than 30 mmHg. Subjects with higher resting gradients were older with more cardiovascular events. For provoked gradients, a bi-modal risk distribution was found. Patients with provoked gradients > 90 mmHg (HR 3.92, 95% CI 1.97–7.79) or < 30 mmHg (HR 2.15, 95% CI 1.08–4.29) have more events compared to those with gradients between 30 and 89 mmHg in multivariable analysis. The introduction of two cut-off points for provoked gradients allowed HCM to be reclassified into four groups: patients with “benign” latent HCM (provoked gradient 30–89 mmHg) had the best prognosis, whereas those with persistent obstructive HCM had the worst outcome. Conclusions Provoked LVOT pressure gradients offer additional information regarding clinical outcomes in HCM. Applying cut-off points at 30 and 90 mmHg to provoked LVOT pressure gradients further classifies HCM patients into low-, intermediate- and high-risk groups.",
keywords = "Hypertrophic cardiomyopathy, Left ventricle outflow tract obstruction, Stress echocardiography, Survival",
author = "Lu, {Dai Yin} and Bereketeab Hailesealassie and Ioannis Ventoulis and Hongyun Liu and Liang, {Hsin Yueh} and Alexandra Nowbar and Iraklis Pozios and Marco Canepa and Kenneth Cresswell and Luo, {Hong Chang} and Abraham, {M. Roselle} and Abraham, {Theodore P.}",
year = "2017",
month = "9",
doi = "10.1016/j.ijcard.2017.04.039",
volume = "243",
pages = "290--295",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Impact of peak provoked left ventricular outflow tract gradients on clinical outcomes in hypertrophic cardiomyopathy

AU - Lu,Dai Yin

AU - Hailesealassie,Bereketeab

AU - Ventoulis,Ioannis

AU - Liu,Hongyun

AU - Liang,Hsin Yueh

AU - Nowbar,Alexandra

AU - Pozios,Iraklis

AU - Canepa,Marco

AU - Cresswell,Kenneth

AU - Luo,Hong Chang

AU - Abraham,M. Roselle

AU - Abraham,Theodore P.

PY - 2017/9/15

Y1 - 2017/9/15

N2 - Background Hypertrophic cardiomyopathy (HCM) is traditionally classified based on a left ventricular outflow tract (LVOT) pressure gradient of 30 mmHg at rest or with provocation. There are no data on whether 30 mmHg is the most informative cut-off value and whether provoked gradients offer any information regarding outcomes. Methods Resting and provoked peak LVOT pressure gradients were measured by Doppler echocardiography in patients fulfilling guidelines criteria for HCM. A composite clinical outcome including new onset atrial fibrillation, ventricular tachycardia/fibrillation, heart failure, transplantation, and death was examined over a median follow-up period of 2.1 years. Results Among 536 patients, 131 patients had resting LVOT gradients greater than 30 mmHg. Subjects with higher resting gradients were older with more cardiovascular events. For provoked gradients, a bi-modal risk distribution was found. Patients with provoked gradients > 90 mmHg (HR 3.92, 95% CI 1.97–7.79) or < 30 mmHg (HR 2.15, 95% CI 1.08–4.29) have more events compared to those with gradients between 30 and 89 mmHg in multivariable analysis. The introduction of two cut-off points for provoked gradients allowed HCM to be reclassified into four groups: patients with “benign” latent HCM (provoked gradient 30–89 mmHg) had the best prognosis, whereas those with persistent obstructive HCM had the worst outcome. Conclusions Provoked LVOT pressure gradients offer additional information regarding clinical outcomes in HCM. Applying cut-off points at 30 and 90 mmHg to provoked LVOT pressure gradients further classifies HCM patients into low-, intermediate- and high-risk groups.

AB - Background Hypertrophic cardiomyopathy (HCM) is traditionally classified based on a left ventricular outflow tract (LVOT) pressure gradient of 30 mmHg at rest or with provocation. There are no data on whether 30 mmHg is the most informative cut-off value and whether provoked gradients offer any information regarding outcomes. Methods Resting and provoked peak LVOT pressure gradients were measured by Doppler echocardiography in patients fulfilling guidelines criteria for HCM. A composite clinical outcome including new onset atrial fibrillation, ventricular tachycardia/fibrillation, heart failure, transplantation, and death was examined over a median follow-up period of 2.1 years. Results Among 536 patients, 131 patients had resting LVOT gradients greater than 30 mmHg. Subjects with higher resting gradients were older with more cardiovascular events. For provoked gradients, a bi-modal risk distribution was found. Patients with provoked gradients > 90 mmHg (HR 3.92, 95% CI 1.97–7.79) or < 30 mmHg (HR 2.15, 95% CI 1.08–4.29) have more events compared to those with gradients between 30 and 89 mmHg in multivariable analysis. The introduction of two cut-off points for provoked gradients allowed HCM to be reclassified into four groups: patients with “benign” latent HCM (provoked gradient 30–89 mmHg) had the best prognosis, whereas those with persistent obstructive HCM had the worst outcome. Conclusions Provoked LVOT pressure gradients offer additional information regarding clinical outcomes in HCM. Applying cut-off points at 30 and 90 mmHg to provoked LVOT pressure gradients further classifies HCM patients into low-, intermediate- and high-risk groups.

KW - Hypertrophic cardiomyopathy

KW - Left ventricle outflow tract obstruction

KW - Stress echocardiography

KW - Survival

UR - http://www.scopus.com/inward/record.url?scp=85025081427&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85025081427&partnerID=8YFLogxK

U2 - 10.1016/j.ijcard.2017.04.039

DO - 10.1016/j.ijcard.2017.04.039

M3 - Article

VL - 243

SP - 290

EP - 295

JO - International Journal of Cardiology

T2 - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -