Ciabatti Michele, Fumagalli Carlo, Beltrami Matteo, Vignini Elisa, Martinese Lucia, Tomberli Alessia, Zampieri Mattia, Bertini Alenya, Carrassa Gianmarco, Marchi Alberto, Berteotti Martina, Cappelli Francesco, Bolognese Leonardo, Pieroni Maurizio, Olivotto Iacopo
Cardiomyopathy Unit, Cardiothoracic and Vascular Department, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
Cardiomyopathy Unit, Cardiothoracic and Vascular Department, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy..
Int J Cardiol. 2020 Nov 1;318:94-100. doi: 10.1016/j.ijcard.2020.07.036. Epub 2020 Jul 29.
Despite numerous studies assessing the natural history of patients with hypertrophic cardiomyopathy (HCM), there is lack of data regarding the burden of hospitalization. Aim of this study was to describe prevalence, causes and predictors of cardiovascular hospitalization in patients with HCM.
We retrospectively included 253 patients with HCM undergoing first evaluation at our center. Enrolment criteria included cardiac magnetic resonance imaging (CMRI) at baseline and > 1-year follow-up. All hospital admissions were recorded during follow-up and adjudicated as acute vs elective and cardiovascular (CV) vs non-cardiovascular (non-CV).
During 6.4 ± 4.0 years there were 187 hospitalizations in 92 patients (36%, at a rate of 5.7%/year). Most were CV-related (158/187,84.5%; 4.8%/year) while non-CV admissions were 29/187 (15.5%, 0.88%/year). There was a slight predominance of elective (n = 96, 58%, 2.8%/year) vs acute (n = 62, 41.8%, 2.0%/year) CV hospitalizations. Independent predictors of CV hospitalization were baseline symptoms (NYHA class II vs I: HR 2.06; 95% CI 1.24-3.43, NYHA III-IV vs I: HR 3.05; 95% CI 1.40-6.65, p = .004), indexed left atrial (LA) volume (HR 1.03; 95% CI 1.01-1.04, p < .001), and lower indexed right ventricular end-diastolic volume iRVEDV) at cardiac magnetic resonance (HR 0.99; 95% CI 0.97-0.99, p = .03).
In little over 6 years, CV hospitalization was required in over one-in-three of our HCM patients, often unplanned and due to acute disease-related complications. Symptomatic status, larger LA volume and reduced iRVEDV at baseline were independently associated with CV admissions. Strategies aimed at preventing hospitalizations are an important target to reduce the burden of disease in HCM patients.
尽管有大量研究评估肥厚型心肌病（HCM）患者的自然病史，但关于住院负担的数据仍然缺乏。本研究的目的是描述HCM患者心血管住院的患病率、原因和预测因素。
我们回顾性纳入了253例在本中心接受首次评估的HCM患者。纳入标准包括基线时的心脏磁共振成像（CMRI）和超过1年的随访。随访期间记录所有住院情况，并判定为急性与择期以及心血管（CV）与非心血管（非CV）。
在6.4±4.0年期间，92例患者（36%）有187次住院（年发生率为5.7%）。大多数与CV相关（158/187，84.5%；年发生率4.8%），而非CV住院为29/187（15.5%，年发生率0.88%）。择期CV住院（n = 96，58%，年发生率2.8%）略多于急性CV住院（n = 62，41.8%，年发生率2.0%）。CV住院的独立预测因素为基线症状（纽约心脏协会[NYHA]II级与I级：HR 2.06；95%CI 1.24 - 3.43，NYHA III - IV级与I级：HR 3.05；95%CI 1.40 - 6.65，p = 0.004）、左心房（LA）指数化容积（HR 1.03；95%CI 1.01 - 1.04，p < 0.001）以及心脏磁共振检查时较低的右心室舒张末期指数化容积（iRVEDV）（HR 0.99；95%CI 0.97 - 0.99，p = 0.03）。
在略超过6年的时间里，超过三分之一的HCM患者需要CV住院，且往往是意外情况，原因是急性疾病相关并发症。基线时的症状状态、较大的LA容积和降低的iRVEDV与CV住院独立相关。旨在预防住院的策略是减轻HCM患者疾病负担的重要目标。
