Warning indicators for heart transplantation requirement at the time of hypertrophic cardiomyopathy diagnosis.
Timely identification of hypertrophic cardiomyopathy (HCM) patients who may require a heart transplant (HT) in the future is crucial. Our study aimed to identify predictive factors associated with the need for HT in HCM patients.
All patients undergoing HT due to HCM in a tertiary HT hospital from 2003 to 2020 were included and compared - matched 1:4 for similar follow-up time since diagnosis - to a control HCM cohort. Patients' clinical and imaging characteristics at HCM diagnosis and longitudinal data were assessed.
85 patients, 17 who required a HT and 68 HCM control patients from the HCM clinic, were included. At HCM diagnosis, patients who would later require HT had higher NT-proBNP levels (880.5 vs. 86.2 pg/mL), larger left atrium (LA) dimensions (49 vs. 40 mm), and slightly reduced left ventricle (LV) ejection fraction (50 vs. 60%), and showed higher prevalence of atrial fibrillation (AF) (47 vs. 22%). During a median follow-up of 11.6 years, patients subsequently requiring HT developed further worsening functional class and higher incidence of hospital admission for HF and incidence of sustained ventricular tachycardia or appropriate implantable cardioverter-defibrillator (ICD) ther-apy (log-rank p < 0.001 in both). This was accompanied by significant LA dilatation (8 vs. 1 mm, p = 0.037) and worsening LV diastolic function.
Left atrium dilatation, AF, elevated NT-proBNP levels, and lower LV ejection fraction at HCM diagnosis should alert about the potential future need for HT. Progressive LA enlargement and worsening diastolic function during follow-up are warning signs that should prompt referral to a HT center.
All patients undergoing HT due to HCM in a tertiary HT hospital from 2003 to 2020 were included and compared - matched 1:4 for similar follow-up time since diagnosis - to a control HCM cohort. Patients' clinical and imaging characteristics at HCM diagnosis and longitudinal data were assessed.
85 patients, 17 who required a HT and 68 HCM control patients from the HCM clinic, were included. At HCM diagnosis, patients who would later require HT had higher NT-proBNP levels (880.5 vs. 86.2 pg/mL), larger left atrium (LA) dimensions (49 vs. 40 mm), and slightly reduced left ventricle (LV) ejection fraction (50 vs. 60%), and showed higher prevalence of atrial fibrillation (AF) (47 vs. 22%). During a median follow-up of 11.6 years, patients subsequently requiring HT developed further worsening functional class and higher incidence of hospital admission for HF and incidence of sustained ventricular tachycardia or appropriate implantable cardioverter-defibrillator (ICD) ther-apy (log-rank p < 0.001 in both). This was accompanied by significant LA dilatation (8 vs. 1 mm, p = 0.037) and worsening LV diastolic function.
Left atrium dilatation, AF, elevated NT-proBNP levels, and lower LV ejection fraction at HCM diagnosis should alert about the potential future need for HT. Progressive LA enlargement and worsening diastolic function during follow-up are warning signs that should prompt referral to a HT center.
Authors
Ramos-Jovani Ramos-Jovani, LĂłpez-Sainz LĂłpez-Sainz, Brufau Brufau, RodrĂguez-Arias RodrĂguez-Arias, SolĂ© SolĂ©, Quintana Quintana, Farrero Farrero, Castel Castel, Caravaca Caravaca, Arbelo Arbelo, Sandoval Sandoval, Pereda Pereda, CastellĂ CastellĂ , Sitges Sitges, GarcĂa-Ălvarez GarcĂa-Ălvarez
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