Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, OH, USA.
Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Int J Cardiol. 2024 Oct 15;413:132396. doi: 10.1016/j.ijcard.2024.132396. Epub 2024 Jul 28.
The pathophysiology of HCM presents unique challenges for the management of cardiogenic shock and the use of mechanical circulatory support devices (MCSD). However, outcomes investigations for MCSD and HT in HCM patients is limited to case reports. The present study investigated MCSD and HT outcomes in HCM patients in a large retrospective cohort.
The National Inpatient Sample (2016-2019) was used for the retrospective analysis of patients hospitalized for MCSD and HT using ICD-10 codes. Patients with implantation of more than one device category were excluded. These patients were divided into two cohorts, with and without HCM, and compared in terms of in-hospital mortality, trends in mortality rates, hospitalization costs and mean length of stay.
Among 267,780 patients hospitalized for MCSD and HT, 1155 patients had underlying HCM. Underlying HCM was associated with increased odds of mortality in patients receiving left ventricular assist devices (LVAD) (OR 3.4, 95% CI 1.03-11.2, p = 0.04) and temporary MCSD (OR 2.5, CI 1.8-3.6, p < 0.001). HCM was not associated with increased mortality in patients hospitalized for HT (OR 0.67, CI 0.15-2.85, p = 0.6). Patients with HCM undergoing MCSD and HT had a longer mean length of stay (22.1 vs 13.2 days, p = 0.004), and higher mean hospitalization charges ($830,103 vs $460,383, p < 0.0001) as compared to non-HCM patients.
Underlying HCM is associated with increased in-hospital mortality in patients undergoing LVAD and temporary MCSD placement. Further prospective studies are required to expand our understanding of prognosis among HCM patients undergoing MCSD and establish management guidelines.
HCM 的病理生理学对心源性休克的治疗和机械循环支持设备（MCSD）的使用提出了独特的挑战。然而，针对 HCM 患者的 MCSD 和 HT 的研究结果仅限于病例报告。本研究通过一项大型回顾性队列研究调查了 HCM 患者的 MCSD 和 HT 结局。
使用国家住院患者样本（2016-2019 年），通过 ICD-10 代码对因 MCSD 和 HT 住院的患者进行回顾性分析。排除植入多种设备类别的患者。这些患者分为两组，有和没有 HCM，并比较住院死亡率、死亡率趋势、住院费用和平均住院时间。
在 267780 例因 MCSD 和 HT 住院的患者中，有 1155 例患者存在潜在的 HCM。在接受左心室辅助装置（LVAD）治疗的患者中，潜在的 HCM 与死亡风险增加相关（OR 3.4，95%CI 1.03-11.2，p=0.04）和临时 MCSD（OR 2.5，CI 1.8-3.6，p<0.001）。在因 HT 住院的患者中，HCM 与死亡率增加无关（OR 0.67，CI 0.15-2.85，p=0.6）。接受 MCSD 和 HT 的 HCM 患者的平均住院时间较长（22.1 天 vs 13.2 天，p=0.004），平均住院费用较高（830103 美元 vs 460383 美元，p<0.0001）与非 HCM 患者相比。
在接受 LVAD 和临时 MCSD 植入的患者中，潜在的 HCM 与住院死亡率增加相关。需要进一步的前瞻性研究来扩大我们对接受 MCSD 的 HCM 患者预后的理解，并制定管理指南。
