Objective To investigate whether low-normal left ventricular ejection fraction (LVEF) is associated with adverse outcomes in hypertrophic cardiomyopathy (HCM) and evaluate the incremental value of predictive power of LVEF in the conventional HCM sudden cardiac death (SCD)-risk model.
Methods This retrospective study included 1858 patients with HCM from two tertiary hospitals between 2008 and 2019. We classified LVEF into three categories: preserved (≥60%), low normal (50%–60%) and reduced (<50%); there were 1399, 415, and 44 patients with preserved, low-normal, and reduced LVEF, respectively. The primary outcome was a composite of SCD, ventricular tachycardia/fibrillation and appropriate implantable cardioverter-defibrillator shocks. Secondary outcomes were hospitalisation for heart failure (HHF), cardiovascular death and all-cause death.
Results During the median follow-up of 4.09 years, the primary outcomes occurred in 1.9%. HHF, cardiovascular death, and all-cause death occurred in 3.3%, 1.9%, and 5.3%, respectively. Reduced LVEF was an independent predictor of SCD/equivalent events (adjusted HR (aHR) 5.214, 95% CI 1.574 to 17.274, p=0.007), adding predictive value to the HCM risk-SCD model (net reclassification improvement 0.625). Compared with patients with HCM with preserved LVEF, those with low-normal and reduced LVEF had a higher risk of HHF (LVEF 50%–60%, aHR 2.457, 95% CI 1.423 to 4.241, p=0.001; LVEF <50%, aHR 7.937, 95% CI 3.315 to 19.002, p<0.001) and cardiovascular death (LVEF 50%–60%, aHR 2.641, 95% CI 1.314 to 5.309, p=0.006; LVEF <50%, aHR 5.405, 95% CI 1.530 to 19.092, p=0.009), whereas there was no significant association with all-cause death.
Conclusions Low-normal LVEF was an independent predictor of HHF and cardiovascular death in patients with HCM.
- Hypertrophic cardiomyopathy
- SUDDEN CARDIAC DEATH
- Heart Failure, Systolic
- Outcome Assessment, Health Care
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
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Contributors YJ Choi and HK Kim designed the study. HK Kim developed the theory and performed the computations. HKK, ICH, JBP, YEY, SPL, GYC, and YJK acquired data (patient recruitment). HK Kim, IC Hwang, and YJ Choi verified the analytical methods. HK Kim and IC Hwang encouraged YJ Choi to investigate and supervised the findings of this work. CS Park, TM Rhee, HJ Lee, JB Park, YE Yoon, SP Lee, GY Cho, and YJ Kim contributed to the interpretation of the results. YJ Choi, IC Hwang, and HK Kim wrote the manuscript. All authors approved the final version and are accountable for the integrity of the work. HKK and ICH accept full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.
Funding This study was supported by a research grant from Seoul National University Research fund (no. 800-20210548) and partly by a research grant from Chong-Kun-Dang (no. 0620214840).
Competing interests G-YC is an International Editorial Advisory Board member for Heart.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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