Abstract
Introduction: Data on the incidence, natural history and treatments of biventricular obstruction hypertrophic cardiomyopathy are limited. Objective: We aimed to the compare midterm outcomes of surgery and medication in biventricular outflow tract obstruction(BVOTO) HCM with left ventricular outflow tract obstruction (LVOTO) HCM and non-obstructive hypertrophic cardiomyopathy (NOHCM). Methods: Among 4945 HCM patients, we identified 43 with BVOTO and recruited age and sex matched 54 with LVOTO and 52 with NOHCM. The primary endpoint was all cause death and second endpoints were cardiovascular events. Results: Age and male were paired among BVOTO, LVOTO and NOHCM (26±17 ys, 30±18 ys, 31±16 ys P=0.3; 57%, 66%, 69%, p=0.5). More patients with BVOTO (69%) had NYHA III/IV than with LVOTO (51%)and NOHCM (15%) (p=0.000). And patients with BVOTO (5.6%±4 %) had higher risk of SCD than with LVOTO (3.9%±1.8%) and NOHCM (2.9%±2.1%)(p=0.000). In BVOTO, 20 patients had left-and-right sided correction (LRVC-B) (1 died and 5 had III AVB), 12 patients accepted left-sided correction (LVC-B) (1 died and 1 occurred III AVB) while 11 patients received medication. At the last follow-up, patients in LRVC-B and LVC-B had a reduction in left and right ventricular intracavity pressure gradient and NYHA class (vs before myectomy, p < 0.001). And no death occurred in the remained 147 patients. The second endpoint-free survival rates of BVOTO were less than LVOTO and NOHCM while the rates were similar among LRVC-B, LVC-B, LVC-L and NOHCM groups. (Fig1ab) Independent predictors of the second endpoint were age (HR 1.05,95%CI 1.0-1.1), RVOTO (HR 1.06,95%CI 1.03-1.10), myectomy (HR 0.16,95%CI 0.03-0.61) and pre-NYHA (HR 4.1,95%CI 2.1-8.33). Conclusions: Patients with BVOTO had more severe symptoms. Both LRVC-B and LVC-B could improve symptom but LRVC-B had a higher risk of III AVB. Mid-term outcomes after surgical correction in BVOTO were similar to that in NOHCM.
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