Predictors of Long Term Outcomes in Symptomatic Hypertrophic Obstructive Cardiomyopathy Patients Undergoing Surgical Relief of Left Ventricular Outflow Tract Obstruction
Background—We report the predictors of long-term outcomes of symptomatic hypertrophic cardiomyopathy (HCM) patients undergoing surgical relief of left ventricular outflow tract (LVOT) obstruction.
Methods and Results—We studied 699 consecutive HCM patients with severe symptomatic LVOT obstruction (47±11 years, 63% male) intractable to maximal medical therapy, that were referred to a tertiary hospital between 1/1997 and 12/2007 for surgical relief of LVOT obstruction. We excluded patients < 18 years and those with ejection fraction < 50%, hypertensive heart disease of elderly and > mild aortic or mitral stenosis. Clinical, echocardiographic, and Holter data was recorded. A composite endpoint of death, appropriate internal cardioverter defibrillator discharges, resuscitated sudden death, documented stroke and admission for congestive heart failure was recorded. During a mean follow-up of 6.2 ± 3 years, 86 patients (12%) met the composite endpoint with 30-day, 1-year and 2-year event rate of 0.7%, 2.8% and 4.7%, respectively. The hard event rate (death, defibrillator discharge and resuscitated sudden death) at 30-day, 1-year and 2-years was 0%, 1.5% and 3%, respectively. Stepwise multivariable analysis identified residual postoperative AF (Hazard ratio 2.12 [1.37-3.34] p=0.001), and increasing age (Hazard ratio 1.49 [1.22-1.82] p=0.001) as independent predictors of long-term composite outcomes.
Conclusions—Symptomatic adult HCM patients undergoing surgery for relief of LVOT obstruction have low event rate during long-term follow up; with worse outcomes predicted by increasing age and presence of residual AF during follow up.
- Received December 21, 2012.
- Revision received April 26, 2013.
- Accepted May 20, 2013.