Myocardial deformation as a stratification tool in HCM

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Sudden cardiac death (SCD) is a major issue in hypertrophic cardiomyopathy (HCM) management, and its risk prediction stays challenging for clinicians. Ventricular arrythmias (VAs) have to be treated rapidly, indeed VAs lower prognosis in HCM patients. Current ESC guidelines for cardioverter-defibrillator implantation include left atrial (LA) whereas left ventricle (LV) ejection function (LVEF) is incorporated in AHA latest guidelines. We explore the potential role of LA and LV strain as more sensible parameters in HCM rhythmic prognostication. Purpose To assess LA and LV strain in risk stratification in HCM patients as accurate markers of SCD. Methods Patients with newly diagnosed HCM were enrolled in three French University Hospital (Marseille, Bordeaux and Rennes) between 2007 and 2018. At the inclusion we realized a comprehensive clinical exam, biological analysis, an echocardiography including LA strain in two and four apical-chambers, and a MRI. Composite primary endpoint (PE) analysis was occurrence of rhythmic related adverse cardiac events: ventricular tachycardia (VT), ICD therapy for ventricular arrhythmia, or all-cause death. Occurrence and dates of endpoints were retrieved by patient’s medical records and phone calls to all patients and family members. Results At a mean follow-up of 57 (34–82) months, patients with adverse cardiac events (n = 52) presented with more impaired LA and LV deformation function. After multivariate analysis, we found a significant association between impaired LA strain and our composite primary endpoint P 0,023 HR 0,95. LV strain revealed to be correlated with our PE P 0,012 HR 2,48. Conclusions Myocardial deformation appears to be a relevant marker which could be linked to sudden cardiac death in HCM. These parameters might be relevant in new risk calculators.