Park Chan Soon, Rhee Tae-Min, Lee Hyun Jung, Yoon Yeonyee E, Park Jun-Bean, Lee Seung-Pyo, Kim Yong-Jin, Cho Goo-Yeong, Hwang In-Chang, Kim Hyung-Kwan
Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Korean Circ J. 2023 Sep;53(9):606-618. doi: 10.4070/kcj.2023.0035.
The prognostic or safety implication of renin-angiotensin-aldosterone system inhibitors (RASi) in hypertrophic cardiomyopathy (HCM) are not well established, mainly due to concerns regarding left ventricular outflow tract (LVOT) obstruction aggravation. We investigated the implications of RASi in a sizable number of HCM patients.
We enrolled 2,104 consecutive patients diagnosed with HCM in 2 tertiary university hospitals and followed up for five years. RASi use was defined as the administration of RASi after diagnostic confirmation of HCM. The primary and secondary outcomes were all-cause mortality and hospitalization for heart failure (HHF).
RASi were prescribed to 762 patients (36.2%). During a median follow-up of 48.1 months, 112 patients (5.3%) died, and 94 patients (4.5%) experienced HHF. Patients using RASi had less favorable baseline characteristics than those not using RASi, such as older age, more frequent history of comorbidities, and lower ejection fraction. Nonetheless, there was no difference in clinical outcomes between patients with and without RASi use (log-rank p=0.368 for all-cause mortality and log-rank p=0.443 for HHF). In multivariable analysis, patients taking RASi showed a comparable risk of all-cause mortality (hazard ratio [HR], 0.70, 95% confidence interval [CI], 0.43-1.14, p=0.150) and HHF (HR, 1.03, 95% CI, 0.63-1.70, p=0.900). In the subgroup analysis, there was no significant interaction of RASi use between subgroups stratified by LVOT obstruction, left ventricular (LV) ejection fraction, or maximal LV wall thickness.
RASi use was not associated with worse clinical outcomes. It might be safely administered in patients with HCM if clinically indicated.
肾素 - 血管紧张素 - 醛固酮系统抑制剂（RASi）在肥厚型心肌病（HCM）中的预后或安全性影响尚未明确，主要是因为担心其会加重左心室流出道（LVOT）梗阻。我们对大量HCM患者中RASi的影响进行了研究。
我们纳入了2家三级大学医院连续诊断出的2104例HCM患者，并进行了5年的随访。RASi的使用定义为在HCM诊断确认后给予RASi。主要和次要结局分别是全因死亡率和心力衰竭住院（HHF）。
762例患者（36.2%）使用了RASi。在中位随访48.1个月期间，112例患者（5.3%）死亡，94例患者（4.5%）发生HHF。使用RASi的患者基线特征比未使用RASi的患者更差，如年龄更大、合并症病史更频繁、射血分数更低。尽管如此，使用和未使用RASi的患者临床结局并无差异（全因死亡率的对数秩检验p = 0.368，HHF的对数秩检验p = 0.443）。在多变量分析中，服用RASi的患者全因死亡率风险相当（风险比[HR]，0.70，95%置信区间[CI]，0.43 - 1.14，p = 0.150），HHF风险也相当（HR，1.03，95%CI，0.63 - 1.70，p = 0.900）。在亚组分析中，按LVOT梗阻、左心室（LV）射血分数或最大LV壁厚度分层的亚组之间，RASi使用并无显著交互作用。
使用RASi与更差的临床结局无关。如果有临床指征，HCM患者可能可以安全使用。
