Abstract 11092: Higher Risk Prognosis for Major Cardiac Events in Hypertrophic Cardiomyopathy with Myocardial Fibrosis by CT Following a Median of 32 Months Using Kaplan-Meier and Cox Proportional Hazard Regression
Purpose: To evaluate the prognosis of hypertrophic cardiomyopathy (HCM) patients after cardiac CT and compare the risk of major adverse cardiac events (MACE) between HCM patients with and without focal myocardial fibrosis (MF) on CT using a Kaplan-Meier and Cox proportional hazard model.
Material and methods: A total of 57 consecutive patients with HCM by transthoracic echocardiogram, (39 male, mean age 62.2 ± 14.4 years, Maron type 1 (8), type 2 (1), type 3 (32), and type 5 (16)), who had suspected coronary artery disease without old myocardial infarction and who underwent cardiac CT on which no significant luminal stenosis (>50%) was observed, were included. Enhanced ECG gated MSCT was performed at 30 seconds and 6 minutes after contrast injection to detect MF as contrast defects in the early phase and abnormal enhancement in late phase. Patients were followed for a median of 43.0 ± 29.8 months after cardiac CT. The incidence of MACE was compared with a Kaplan -Meier analysis and the log rank statistic.
Result: MF on CT was detected in 31 subjects. Patients with MF had a higher risk of MACE (22.6%) than those without (3.8%; p=0.04) during the observation period. Significant differences between HCM subjects with and without MF were also seen at each time point and when the whole period of follow-up was compared with a Kaplan-Meier and log rank test (p=0.02; Figure). A Cox proportional hazards model was used to test the significance of MF on CT as a predictor of MACE considering the influence of male sex, left ventricular asynergy, hypertrophic obstructive cardiomyopachy, apical hypertrophy, and time duration from the onset of HCM. This analysis revealed that the presence of MF on CT was a predictor of MACE (Hazard ratio 17.0, p=0.03).
Conclusion: HCM patients without coronary luminal stenosis but with MF on cardiac CT had a higher risk of MACE than those without following a median of 32 months using a Kaplan-Meier analysis and Cox proportional hazard regression with a hazard ratio of 16.6.
- © 2011 by American Heart Association, Inc.