Value of echocardiography in estimating functional status and event-risk in patients with hypertrophic cardiomyopathy

Abstract

The prognosis in patients with hypertrophic cardiomyopathy (HCM) remains complicated to estimate. Exercise testing is recommended. We sought to assess whether the echocardiographic evaluation could help in best understanding the clinical consequences and the event-risk of patients referred for HCM. In total, 302 HCM-patients (57.4 ± 16.8 years old) were analysed. All patients underwent transthoracic rest and stress echocardiography for the evaluation of size and function including strain measurements. A cardiopulmonary exercise test (CPET) was performed by all the patients at the time of echocardiography. The patients were followed for 3.4 years for the occurrence of a composite endpoint including heart failure requiring hospitalization, syncope, ventricular tachycardia (VT) sustained or not, atrial heart rate episode registered by pacemaker or implanted defibrillator, symptomatic supraventricular tachycardia, asymptomatic supraventricular tachycardia detected by Holter, defibrillator implantation, myomectomy/septal alcoholising, or HCM related death. Mean VO2 peak for all patients was 21.57 ± 7.6 mL/kg/min. The best predictors of peak VO2 were increased exercise mean E/Ea (9.17 [6.30–12.9]), decreased resting TAPSE (22.5 ± 4.99 mm) and decreased exercise LV GLS (−17.6 ± 3.97%). Among the 302 patients, 132 (43.8%) met the composite endpoint. Among clinical, CPET and echocardiographic parameters recorded, PLAS was the best predictor of event with linear association. The decrease in PLAS was strongly associated with the risk of event. It takes over CPET results. On top of this prognostic value, echocardiographic evaluation was demonstrated extremely relevant for our daily evaluation of HCM-patients.