Abstract 16084: Progression of Myocardial Dysfunction in Hypertrophic Cardiomyopathy Patients: Association With Heart Failure Outcomes
Introduction: Serial echocardiographic studies in hypertrophic cardiomyopathy (HCM) are lacking and little is known about the natural progression of left ventricular (LV) structural and functional abnormalities in these patients. Furthermore, whether a worsening in LV function over time is associated with the development of heart failure (HF) has not been explored.
Hypothesis: We hypothesized that LV dysfunction is a progressive phenomenon in HCM patients which could be measured by echocardiography and particularly applying more sensitive techniques such as speckle tracking strain imaging. Importantly, a worsening in LV performance could be associated with HF outcomes.
Methods: Transthoracic echocardiography was performed in 279 HCM patients (69% male, age 50±14 years) at their initial visit and during follow-up (median time 6.3 (IQR 3.8-9.5) years). Changes in echocardiographic variables, including LV global longitudinal strain (GLS) and left atrial volume index (LAVI) during follow-up were assessed using linear mixed model analysis. The endpoint of new HF development or progression to NYHA class III/IV after the follow-up echo was noted and echocardiographic changes over time were compared between patients with and without HF.
Results: A total of 44 patients reached the HF endpoint after the follow-up echocardiography. Echocardiographic parameters remained stable over time in patients without HF, but significantly worsened in patients who developed HF (Figure). In particular, GLS declined from -13±5 to -11±3% (p=0.004) and LAVI increased from 46 (35-62) to 49 (38-67) ml/m2 (p=0.006) in patients with HF; the changes over time were significantly different between the 2 groups (p interaction group-time =0.038 for GLS and p=0.008 for LAVI).
Conclusions: Progression in LV systolic and diastolic dysfunction in HCM patients can be detected by GLS and LAVI. Importantly, changes over time in these echocardiographic parameters are associated with HF outcome.
Author Disclosures: Y.L. Hiemstra: None. P. Debonnaire: None. S.E. van Wijngaarden: None. M. Bootsma: None. M.J. Schalij: Research Grant; Modest; The Department of Cardiology of the Leiden University Medical Center received grants from Biotronik, Medtronic, Boston Scientific Corporation and Edwards Lifesciences. J.J. Bax: None. V. Delgado: Speakers Bureau; Modest; Victoria Delgado received speaker fees from Abbott Vascular. N.A. Marsan: None.
- © 2016 by American Heart Association, Inc.