PMID- 26239580 OWN - NLM STAT- MEDLINE DCOM- 20151116 LR - 20181113 IS - 1879-1913 (Electronic) IS - 0002-9149 (Print) IS - 0002-9149 (Linking) VI - 116 IP - 6 DP - 2015 Sep 15 TI - Comparison of Outcomes in Patients With Nonobstructive, Labile-Obstructive, and Chronically Obstructive Hypertrophic Cardiomyopathy. PG - 938-44 LID - S0002-9149(15)01534-9 [pii] LID - 10.1016/j.amjcard.2015.06.018 [doi] AB - Patients with nonobstructive hypertrophic cardiomyopathy (HC) are considered low risk, generally not requiring aggressive intervention. However, nonobstructive and labile-obstructive HC have been traditionally classified together, and it is unknown if these 2 subgroups have distinct risk profiles. We compared cardiovascular outcomes in 293 patients HC (96 nonobstructive, 114 labile-obstructive, and 83 obstructive) referred for exercise echocardiography and magnetic resonance imaging and followed for 3.3 +/- 3.6 years. A subgroup (34 nonobstructive, 28 labile-obstructive, 21 obstructive) underwent positron emission tomography. The mean number of sudden cardiac death risk factors was similar among groups (nonobstructive: 1.4 vs labile-obstructive: 1.2 vs obstructive: 1.4 risk factors, p = 0.2). Prevalence of late gadolinium enhancement (LGE) was similar across groups but more non-obstructive patients had late gadolinium enhancement >/=20% of myocardial mass (23 [30%] vs 19 [18%] labile-obstructive and 8 [11%] obstructive, p = 0.01]. Fewer labile-obstructive patients had regional positron emission tomography perfusion abnormalities (12 [46%] vs nonobstructive 30 [81%] and obstructive 17 [85%], p = 0.003]. During follow-up, 60 events were recorded (36 ventricular tachycardia/ventricular fibrillation, including 30 defibrillator discharges, 12 heart failure worsening, and 2 deaths). Nonobstructive patients were at greater risk of VT/VF at follow-up, compared to labile obstructive (hazed ratio 0.18, 95% confidence interval 0.04 to 0.84, p = 0.03) and the risk persisted after adjusting for age, gender, syncope, family history of sudden cardiac death, abnormal blood pressure response, and septum >/=3 cm (p = 0.04). Appropriate defibrillator discharges were more frequent in nonobstructive (8 [18%]) compared to labile-obstructive (0 [0%], p = 0.02) patients. In conclusion, nonobstructive hemodynamics is associated with more pronounced fibrosis and ischemia than labile-obstructive and is an independent predictor of VT/VF in HC. CI - Copyright (c) 2015 Elsevier Inc. All rights reserved. FAU - Pozios, Iraklis AU - Pozios I AD - Johns Hopkins HCM Center of Excellence, Baltimore, Maryland. FAU - Corona-Villalobos, Celia AU - Corona-Villalobos C AD - Department of Radiology, Johns Hopkins University, Baltimore, Maryland. FAU - Sorensen, Lars L AU - Sorensen LL AD - Johns Hopkins HCM Center of Excellence, Baltimore, Maryland. FAU - Bravo, Paco E AU - Bravo PE AD - Department of Radiology, Johns Hopkins University, Baltimore, Maryland. FAU - Canepa, Marco AU - Canepa M AD - Johns Hopkins HCM Center of Excellence, Baltimore, Maryland. FAU - Pisanello, Chiara AU - Pisanello C AD - Johns Hopkins HCM Center of Excellence, Baltimore, Maryland. FAU - Pinheiro, Aurelio AU - Pinheiro A AD - Johns Hopkins HCM Center of Excellence, Baltimore, Maryland. FAU - Dimaano, Veronica L AU - Dimaano VL AD - Johns Hopkins HCM Center of Excellence, Baltimore, Maryland. FAU - Luo, Hongchang AU - Luo H AD - Johns Hopkins HCM Center of Excellence, Baltimore, Maryland. FAU - Dardari, Zeina AU - Dardari Z AD - Johns Hopkins HCM Center of Excellence, Baltimore, Maryland. FAU - Zhou, Xun AU - Zhou X AD - Johns Hopkins HCM Center of Excellence, Baltimore, Maryland. FAU - Kamel, Ihab AU - Kamel I AD - Department of Radiology, Johns Hopkins University, Baltimore, Maryland. FAU - Zimmerman, Stefan L AU - Zimmerman SL AD - Department of Radiology, Johns Hopkins University, Baltimore, Maryland. FAU - Bluemke, David A AU - Bluemke DA AD - Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Maryland. FAU - Abraham, M Roselle AU - Abraham MR AD - Johns Hopkins HCM Center of Excellence, Baltimore, Maryland. FAU - Abraham, Theodore P AU - Abraham TP AD - Johns Hopkins HCM Center of Excellence, Baltimore, Maryland. Electronic address: tabraha3@jhmi.edu. LA - eng GR - R01 HL098046/HL/NHLBI NIH HHS/United States GR - HL 098046/HL/NHLBI NIH HHS/United States PT - Comparative Study PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20150626 PL - United States TA - Am J Cardiol JT - The American journal of cardiology JID - 0207277 SB - IM MH - Adult MH - Aged MH - Cardiomyopathy, Hypertrophic/classification/complications/diagnosis/*physiopathology MH - Cohort Studies MH - Disease Progression MH - Echocardiography, Stress MH - Female MH - Heart/diagnostic imaging MH - Heart Failure/complications/diagnosis/*physiopathology MH - Humans MH - Kaplan-Meier Estimate MH - Magnetic Resonance Imaging MH - Male MH - Middle Aged MH - Myocardial Perfusion Imaging MH - Myocardium/pathology MH - Proportional Hazards Models MH - Tachycardia, Ventricular/*etiology MH - Ventricular Fibrillation/*etiology MH - Ventricular Outflow Obstruction/classification/diagnosis/etiology/*physiopathology PMC - PMC4554842 MID - NIHMS705519 EDAT- 2015/08/05 06:00 MHDA- 2015/11/17 06:00 PMCR- 2016/09/15 CRDT- 2015/08/05 06:00 PHST- 2015/05/19 00:00 [received] PHST- 2015/06/14 00:00 [revised] PHST- 2015/06/14 00:00 [accepted] PHST- 2015/08/05 06:00 [entrez] PHST- 2015/08/05 06:00 [pubmed] PHST- 2015/11/17 06:00 [medline] PHST- 2016/09/15 00:00 [pmc-release] AID - S0002-9149(15)01534-9 [pii] AID - 10.1016/j.amjcard.2015.06.018 [doi] PST - ppublish SO - Am J Cardiol. 2015 Sep 15;116(6):938-44. doi: 10.1016/j.amjcard.2015.06.018. Epub 2015 Jun 26.