Quality of life determinants inpatients with hypertrophic cardiomyopathy and heart failure

Abstract

Quality of life (QOL) is often overlooked in clinical practice. Heart failure (HF) is a major complication of HCM, with more than three quarters of HCM patients (pts) developing HF symptoms. The aim of the study was to evaluate the impact of HF on QOL in HCM pts, as well as the associated major clinical determinants. The present study is a cross-sectional single-center study. Evaluation of all pts was performed based on a comprehensive protocol including clinical, laboratory and imaging studies. All pts were administered the translated validated version of the Kansas City Cardiomyopathy Questionnaire (KCCQ) as a health status measure. The study group included 61 pts (55 ± 14.4 years, 62% men). The mean global KCCQ score was 65.6 ± 24.1 (range: 0–100), corresponding to a mild impairment in QOL. Patients in class II and III NYHA had a significantly worse QOL than class I NYHA, reflected in lower global KCCQ scores (class III NYHA 53.5 ± 16.3 vs class II NYHA 64.7 ± 23.1 vs class I NYHA 89 ± 13.2, P < 0.05). Patients with pulmonary hypertension (PH) had a worse QOL compared to those without PH (mean KCCQ score difference 13.8 ± 3.7, P < 0.05) and were significantly more likely to have had at least one episode of atrial fibrillation (76% vs 30%, P < 0.05). The KCCQ score correlated with the end-systolic LV volume ( r = 0.33, P < 0.05), LVEF ( r = 0.30, P < 0.05), pulmonary velocity acceleration time ( r = 0.32, P < 0.05), serum urea and creatinine ( r = −0.41, P < 0.01 and r = −0.33, P < 0.05, respectively) and age ( r = −0.281, P < 0.05). LVEF (st d β = −0.478, P < 0.05) and serum urea level (std β = −0.352, P < 0.05) emerged as independent predictors of QOL score. Out of the 5 items that make up the global KCCQ score, social limitation had the most significant impact on overall QOL ( R 2 : 0.82, P < 0.05). Patients with HCM and HF present a mild degree of alteration in QOL. LVEF and renal function are independent predictors of perceived health status in these patients.