Choi You-Jung, Kim Hyung-Kwan, Hwang In-Chang, Park Chan Soon, Rhee Tae-Min, Lee Hyun-Jung, Park Jun-Bean, Yoon Yeonyee Elizabeth, Lee Seung-Pyo, Cho Goo-Yeong, Kim Yong-Jin
Internal Medicine, Korea University Guro Hospital, Seoul, Korea (the Republic of).
Clinical Medical Sciences, Seoul National University College of Medicine, Seoul, Korea (the Republic of).
Heart. 2023 Apr 25;109(10):771-778. doi: 10.1136/heartjnl-2022-321853.
To investigate whether low-normal left ventricular ejection fraction (LVEF) is associated with adverse outcomes in hypertrophic cardiomyopathy (HCM) and evaluate the incremental value of predictive power of LVEF in the conventional HCM sudden cardiac death (SCD)-risk model.
This retrospective study included 1858 patients with HCM from two tertiary hospitals between 2008 and 2019. We classified LVEF into three categories: preserved (60%), low normal (50%-60%) and reduced (<50%); there were 1399, 415, and 44 patients with preserved, low-normal, and reduced LVEF, respectively. The primary outcome was a composite of SCD, ventricular tachycardia/fibrillation and appropriate implantable cardioverter-defibrillator shocks. Secondary outcomes were hospitalisation for heart failure (HHF), cardiovascular death and all-cause death.
During the median follow-up of 4.09 years, the primary outcomes occurred in 1.9%. HHF, cardiovascular death, and all-cause death occurred in 3.3%, 1.9%, and 5.3%, respectively. Reduced LVEF was an independent predictor of SCD/equivalent events (adjusted HR (aHR) 5.214, 95% CI 1.574 to 17.274, p=0.007), adding predictive value to the HCM risk-SCD model (net reclassification improvement 0.625). Compared with patients with HCM with preserved LVEF, those with low-normal and reduced LVEF had a higher risk of HHF (LVEF 50%-60%, aHR 2.457, 95% CI 1.423 to 4.241, p=0.001; LVEF <50%, aHR 7.937, 95% CI 3.315 to 19.002, p<0.001) and cardiovascular death (LVEF 50%-60%, aHR 2.641, 95% CI 1.314 to 5.309, p=0.006; LVEF <50%, aHR 5.405, 95% CI 1.530 to 19.092, p=0.009), whereas there was no significant association with all-cause death.
Low-normal LVEF was an independent predictor of HHF and cardiovascular death in patients with HCM.
探讨左心室射血分数（LVEF）略低于正常水平是否与肥厚型心肌病（HCM）的不良结局相关，并评估LVEF在传统HCM心源性猝死（SCD）风险模型中的预测能力增加值。
这项回顾性研究纳入了2008年至2019年间来自两家三级医院的1858例HCM患者。我们将LVEF分为三类：保留（≥60%）、略低于正常（50%-60%）和降低（<50%）；分别有1399例、415例和44例患者LVEF保留、略低于正常和降低。主要结局是SCD、室性心动过速/心室颤动和合适的植入式心律转复除颤器电击的复合结局。次要结局是因心力衰竭住院（HHF）、心血管死亡和全因死亡。
在中位随访4.09年期间，主要结局发生率为1.9%。HHF、心血管死亡和全因死亡发生率分别为3.3%、1.9%和5.3%。LVEF降低是SCD/等效事件的独立预测因素（校正后风险比（aHR）5.214，95%置信区间1.574至17.274，p=0.007），为HCM风险-SCD模型增加了预测价值（净重新分类改善0.625）。与LVEF保留的HCM患者相比，LVEF略低于正常和降低的患者HHF风险更高（LVEF 50%-60%，aHR 2.457，95%置信区间1.423至4.241，p=0.001；LVEF<50%，aHR 7.937，95%置信区间3.315至19.002，p<0.001）和心血管死亡风险更高（LVEF 50%-60%，aHR 2.641，95%置信区间1.314至5.309，p=0.006；LVEF<50%，aHR 5.405，95%置信区间1.530至19.092，p=0.009），而与全因死亡无显著关联。
LVEF略低于正常水平是HCM患者HHF和心血管死亡的独立预测因素。
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