Prognostic Relevance of a Score for Identifying Diastolic Dysfunction according to the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging Recommendations in Patients with Hypertrophic Cardiomyopathy

Abstract

In hypertrophic cardiomyopathy (HCM), one of the main pathophysiological features is diastolic dysfunction. According to the 2016 American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) recommendations, diastolic function is assessed with echocardiographic variables. However, the association between the ASE/EACVI recommendations and the outcome in patients with HCM remains unclear. We evaluated the prognostic implications of the ASE/EACVI recommendations in patients with HCM. This study included 290 patients with HCM. We evaluated four variables for identifying diastolic dysfunction using the following abnormal cutoff values: septal e' < 7cm/sec, septal E/e' ratio > 15, left atrial volume index > 34mL/m2, and peak tricuspid regurgitation velocity > 2.8m/sec. A score was developed in which one point was designated for each abnormal echo parameter of diastolic function. We divided patients into two groups with an ASE/EACVI score of 3 as the cutoff value. The primary endpoint was the combination of HCM-related adverse outcomes (combination of sudden death or potentially lethal arrhythmic events, heart failure-related death, and heart failure hospitalization). The prevalence of an ASE/EACVI score ≥3 was 37.2%. Over a median follow-up of 9.7 (6.9-12.9) years, 26 (24.1%) patients with an ASE/EACVI score ≥3 and 25 (13.7%) patients with an ASE/EACVI score <3 experienced a combination of HCM-related adverse outcomes. Patients with an ASE/EACVI score ≥3 had a significantly higher incidence of the combined endpoint than those with an ASE/EACVI score <3 (log-rank, P=.010). An ASE/EACVI score ≥3 was an independent determinant of the combined endpoint in multivariate analysis (adjusted hazard ratio=1.92; 95% CI, 1.05-3.49; P=.033). The score for identifying diastolic dysfunction by following ASE/EACVI recommendations may be associated with an adverse outcome in patients with HCM.