PMID- 12540642
OWN - NLM
STAT- MEDLINE
DCOM- 20030127
LR  - 20220409
IS  - 1533-4406 (Electronic)
IS  - 0028-4793 (Linking)
VI  - 348
IP  - 4
DP  - 2003 Jan 23
TI  - Effect of left ventricular outflow tract obstruction on clinical outcome in 
      hypertrophic cardiomyopathy.
PG  - 295-303
AB  - BACKGROUND: The influence of left ventricular outflow tract obstruction on the 
      clinical outcome of hypertrophic cardiomyopathy remains unresolved. METHODS: We 
      assessed the effect of outflow tract obstruction on morbidity and mortality in a 
      large cohort of patients with hypertrophic cardiomyopathy who were followed for a 
      mean (+/-SD) of 6.3+/-6.2 years. RESULTS: Of the 1101 consecutive patients, 273 
      (25 percent) had obstruction of left ventricular outflow under basal (resting) 
      conditions with a peak instantaneous gradient of at least 30 mm Hg. A total of 
      127 patients (12 percent) died of hypertrophic cardiomyopathy, and 216 surviving 
      patients (20 percent) had severe, disabling symptoms of progressive heart failure 
      (New York Heart Association [NYHA] functional class III or IV). The overall 
      probability of death related to hypertrophic cardiomyopathy was significantly 
      greater among patients with outflow tract obstruction than among those without 
      obstruction (relative risk, 2.0; P=0.001). The risk of progression to NYHA class 
      III or IV or death specifically from heart failure or stroke was also greater 
      among patients with obstruction (relative risk, 4.4; P<0.001), particularly among 
      patients 40 years of age or older (P<0.001). Age-adjusted multivariate analysis 
      confirmed that outflow tract obstruction was independently associated with an 
      increased risk of both death related to hypertrophic cardiomyopathy (relative 
      risk, 1.6; P=0.02) and progression to NYHA class III or IV or death from heart 
      failure or stroke (relative risk, 2.7; P<0.001). The likelihood of severe 
      symptoms and death related to outflow tract obstruction did not increase as the 
      gradient increased above the threshold of 30 mm Hg. CONCLUSIONS: In patients with 
      hypertrophic cardiomyopathy, left ventricular outflow tract obstruction at rest 
      is a strong, independent predictor of progression to severe symptoms of heart 
      failure and of death.
CI  - Copyright 2003 Massachusetts Medical Society
FAU - Maron, Martin S
AU  - Maron MS
AD  - Division of Cardiology, Tufts-New England Medical Center, Boston, USA.
FAU - Olivotto, Iacopo
AU  - Olivotto I
FAU - Betocchi, Sandro
AU  - Betocchi S
FAU - Casey, Susan A
AU  - Casey SA
FAU - Lesser, John R
AU  - Lesser JR
FAU - Losi, Maria A
AU  - Losi MA
FAU - Cecchi, Franco
AU  - Cecchi F
FAU - Maron, Barry J
AU  - Maron BJ
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - N Engl J Med
JT  - The New England journal of medicine
JID - 0255562
SB  - IM
CIN - N Engl J Med. 2003 May 1;348(18):1815-6; author reply 1815-6. PMID: 12724493
CIN - N Engl J Med. 2003 May 1;348(18):1815-6; author reply 1815-6. PMID: 12728915
CIN - N Engl J Med. 2003 May 1;348(18):1815-6; author reply 1815-6. PMID: 12728916
MH  - Adult
MH  - Cardiomyopathy, Hypertrophic/*complications/mortality
MH  - Death, Sudden, Cardiac/etiology
MH  - Disease Progression
MH  - Female
MH  - Heart Failure/classification/*etiology/mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Proportional Hazards Models
MH  - Prospective Studies
MH  - Risk Factors
MH  - Stroke/mortality
MH  - Ultrasonography
MH  - Ventricular Outflow Obstruction/classification/*complications/diagnostic imaging
EDAT- 2003/01/24 04:00
MHDA- 2003/01/28 04:00
CRDT- 2003/01/24 04:00
PHST- 2003/01/24 04:00 [pubmed]
PHST- 2003/01/28 04:00 [medline]
PHST- 2003/01/24 04:00 [entrez]
AID - 348/4/295 [pii]
AID - 10.1056/NEJMoa021332 [doi]
PST - ppublish
SO  - N Engl J Med. 2003 Jan 23;348(4):295-303. doi: 10.1056/NEJMoa021332.