Abstract 3893: New Independent Predictors for Sudden Death in patients with Hypertrophic Cardiomyopathy in Japan
In patients (pts) with hypertrophic cardiomyopathy (HCM), maximal wall thickness (MWT) ≥30mm, non-sustained ventricular tachycardia (NSVT), family history of sudden death (FH of SD), syncope and abnormal blood pressure response in exercise have been evaluated as strongest risk factors (RF) for sudden death (SD). However, it is controversial whether other HCM disease features such as atrial fibrillation (AF) and left ventricular outflow tract (LVOT) obstruction are independent predictors of SD in HCM. In this study, we evaluate possible RFs for SD in Japanese HCM pts.
Methods: A retrospective study of 410 pts (279 males, mean age at diagnosis: 43±16 years, obstructive HCM: 75 pts), who were diagnosed and followed-up in our hospital, was analyzed. We evaluated a significance of possible RFs, such as MWT≥30mm, NSVT, FH of SD, syncope, AF, LVOT-obstruction (≥30mmHg), and gender, for SD in HCM. SD was defined as sudden cardiac death, non-fatal cardiac arrest, or appropriate ICD interventions.
Results: During 12-year follow-up, SD was observed in 36 pts (9 %). Cox proportional hazards regression analysis identified MWT≥30mm (hazard ratio [HR] =2.90; p=0.04), syncope (HR=2.54; p=0.02), AF (HR=2.69; p=0.006), and LVOT-obstruction (HR=3.70; p=0.002) as independent predictors of SD; NSVT, FH of SD, and gender did not independently predict SD. Furthermore, the probability of SD in HCM pts with more than two or more RFs among MWT, syncope, AF, or LVOT-obstruction was significantly higher than those with no or single RF (p<0.0001, Figure⇓).
Conclusions: This study demonstrates that AF and LVOT-obstruction are independent predictors of SD as well as MWT≥30mm and syncope in Japanese HCM pts.