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Original research
Prognosis of patients with hypertrophic cardiomyopathy and low-normal left ventricular ejection fraction
  1. You-Jung Choi1,2,
  2. Hyung-Kwan Kim3,4,
  3. In-Chang Hwang2,5,
  4. Chan Soon Park3,
  5. Tae-Min Rhee3,4,
  6. Hyun-Jung Lee3,4,
  7. Jun-Bean Park3,4,
  8. Yeonyee Elizabeth Yoon4,5,
  9. Seung-Pyo Lee3,4,
  10. Goo-Yeong Cho2,4,5,
  11. Yong-Jin Kim2,3,4
  1. 1Internal Medicine, Korea University Guro Hospital, Seoul, Korea (the Republic of)
  2. 2Clinical Medical Sciences, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
  3. 3Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of)
  4. 4Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
  5. 5Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  1. Correspondence to Professor Hyung-Kwan Kim, Department of Internal Medicine, Seoul National University Hospital, Seoul, 03080, Korea (the Republic of); cardiman73{at}gmail.com; Assistant professor In-Chang Hwang, Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea (Republic of); inchang.hwang{at}gmail.com

Abstract

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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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • 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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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