Echocardiographic Predictors of All-Cause Mortality in Patients with Hypertrophic Cardiomyopathy following Pacemaker Implantation.

Nixiao Zhang,Chi Cai,Shu Zhang,Yiran Hu,Xuhua Chen,Hongxia Niu,Xiaoping Li,Wei Hua,Min Gu

doi:10.1155/2020/2923767

Abstract

Objectives To examine the association between the echocardiographic parameters measured as left atrial diameter (LAD) and left ventricular end-diastolic diameter (LVEDD) and long-term risk of all-cause mortality in adults with hypertrophic cardiomyopathy (HCM) following pacemaker implantation. Methods A total of 94 adult patients with HCM who underwent pacemaker implantation from November 2002 to June 2013 in our Arrhythmia Center for symptomatic bradycardia and did not receive an implantable cardiac defibrillator (ICD) or cardiac resynchronization therapy (CRT) during follow-up were retrospectively extracted. Results After careful examination of the medical records, we retrospectively evaluated the clinical characteristics of 74 patients with LAD records (58.1 ± 14.9 years) and 76 patients with LVEDD records (57.6 ± 15.2 years). Based on the receiver-operating characteristic (ROC) curve, the values of LAD = 44 mm and LVEDD = 43 mm were identified to predict the all-cause mortality. In the Kaplan–Meier survival, LAD ≥44 mm and LVEDD ≥43 mm were both significantly associated with all-cause mortality (log-rank test P < 0.05). Cox regression analysis indicated that LAD ≥44 mm (HR 3.580; 95% CI = 1.055–12.148; P=0.041) was an independent predictor of all-cause mortality, while LVEDD ≥43 mm was not significantly associated with all-cause mortality. LVOTO was also significantly associated with all-cause mortality (HR = 0.166; 95% CI = 0.036–0.771; P=0.022). Conclusions In HCM patients with pacemaker implantation, LAD ≥44 mm was an independent predictor of all-cause mortality.

Highlights

Permanent pacemaker implantation is an invasive method to treat the severe and/or symptomatic bradycardia, developing due to conditions such as sick sinus syndrome (SSS), high-degree atrioventricular block (AVB), and bradycardia in atrial fibrillation (AF), which is of great importance to symptom relief [1]. e long-term outcomes of this procedure seem to be controversial
A total of 94 adult patients with hypertrophic cardiomyopathy (HCM) and pacemaker implantation at baseline were included in this study. 74 patients with left atrial diameter (LAD) records and 76 patients with left ventricular end-diastolic diameter (LVEDD) records were eligible
We evaluated the all-cause mortality in HCM patients after pacemaker implantation and the baseline echocardiographic predictors measured as LAD and LVEDD

Summary

Introduction

Permanent pacemaker implantation is an invasive method to treat the severe and/or symptomatic bradycardia, developing due to conditions such as sick sinus syndrome (SSS), high-degree atrioventricular block (AVB), and bradycardia in atrial fibrillation (AF), which is of great importance to symptom relief [1]. e long-term outcomes of this procedure seem to be controversial. Previous studies paid more attention to the number of intracardiac electrodes [2, 3], the mode of cardiac pacing (AAI, VVI, and DDD) [2], and the right ventricular pacemaker lead position and their survival differences [2, 4, 5]. Marchandise et al [3] compared single-lead VDD and DDD pacing and found the overall survival after adjustment was not significantly different in the two groups. A study [2] from Germany showed that there was a gradual increase in the survival every decade (P < 0.0001), and differences in the pacing mode and the type of arrhythmia were not significant solely in the last decade during 30-year follow-up. Gender, and the symptoms leading to pacemaker implantation were identified as the independent prognostic factors of survival. The investigators did not do a subgroup analysis of patients with hypertrophic cardiomyopathy (HCM)

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