PMID- 15808767
OWN - NLM
STAT- MEDLINE
DCOM- 20050422
LR  - 20220316
IS  - 0735-1097 (Print)
IS  - 0735-1097 (Linking)
VI  - 45
IP  - 7
DP  - 2005 Apr 5
TI  - The prognostic importance of left ventricular outflow obstruction in hypertrophic 
      cardiomyopathy varies in relation to the severity of symptoms.
PG  - 1076-80
AB  - OBJECTIVES: The aim of this study was to investigate whether the prognostic 
      importance of left ventricular (LV) outflow obstruction in hypertrophic 
      cardiomyopathy (HCM) is influenced by other predictors of morbidity and 
      mortality. BACKGROUND: It remains unknown whether the effect of outflow 
      obstruction on clinical outcome in HCM is influenced by other determinants of 
      survival. METHODS: We assessed the impact of severity of symptoms, LV wall 
      thickness, atrial fibrillation, and age on the prognostic importance of outflow 
      obstruction in a large HCM population. RESULTS: Of 526 consecutive HCM patients, 
      141 (27%) had outflow obstruction. During a follow-up of 4.5 +/- 4.1 years, 34 
      patients died of HCM. The incidence of cardiovascular death was significantly 
      higher among patients with LV obstruction than among those without obstruction 
      (relative risk [RR] = 2.14; p = 0.02). The prognostic power of the outflow 
      gradient changed in relation to severity of symptoms (p = 0.024). At initial 
      evaluation, LV obstruction was a significant predictor of cardiovascular 
      mortality only in New York Heart Association (NYHA) functional class I to II 
      patients (hazard ratio [HR] = 2.38; p = 0.025). During follow-up, at time of 
      development of severe symptoms, the outflow gradient lost its prognostic 
      significance (HR = 1.18; p = 0.66), whereas NYHA functional class III to IV was 
      associated with an eight-fold increase in risk of cardiovascular mortality (HR = 
      7.90; p < 0.001). CONCLUSIONS: In patients with HCM, the prognostic importance of 
      LV outflow obstruction varies in relation to the severity of symptoms. In 
      patients with mild or no symptoms, obstruction is an important predictor of 
      cardiovascular death. After development of severe symptoms, NYHA functional class 
      becomes the dominant marker of prognosis independently of the presence of an 
      outflow gradient.
FAU - Autore, Camillo
AU  - Autore C
AD  - Divisione di Cardiologia, Universita di Roma La Sapienza, Ospedale Sant'Andrea, 
      Via Grottarossa 1035-1039, 00189 Rome, Italy. camillo.autore@uniroma1.it
FAU - Bernabo, Paola
AU  - Bernabo P
FAU - Barilla, Caterina Stella
AU  - Barilla CS
FAU - Bruzzi, Paolo
AU  - Bruzzi P
FAU - Spirito, Paolo
AU  - Spirito P
LA  - eng
GR  - 0860C/TI_/Telethon/Italy
PT  - Evaluation Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
SB  - IM
MH  - Cardiomyopathy, Hypertrophic/complications/diagnostic 
      imaging/*mortality/pathology
MH  - Female
MH  - Humans
MH  - Italy/epidemiology
MH  - Male
MH  - Middle Aged
MH  - Predictive Value of Tests
MH  - Proportional Hazards Models
MH  - *Severity of Illness Index
MH  - Survival Analysis
MH  - Ultrasonography
MH  - Ventricular Outflow Obstruction/complications/diagnostic 
      imaging/*mortality/pathology
EDAT- 2005/04/06 09:00
MHDA- 2005/04/23 09:00
CRDT- 2005/04/06 09:00
PHST- 2004/05/28 00:00 [received]
PHST- 2004/11/02 00:00 [revised]
PHST- 2004/12/21 00:00 [accepted]
PHST- 2005/04/06 09:00 [pubmed]
PHST- 2005/04/23 09:00 [medline]
PHST- 2005/04/06 09:00 [entrez]
AID - S0735-1097(05)00124-5 [pii]
AID - 10.1016/j.jacc.2004.12.067 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2005 Apr 5;45(7):1076-80. doi: 10.1016/j.jacc.2004.12.067.