Prognostic Value of Transthoracic Doppler Echocardiography Coronary Flow Velocity Reserve in Patients With Asymmetric Hypertrophic Cardiomyopathy.

Content Provider	Europe PMC
Author	Tesic, Milorad Beleslin, Branko Giga, Vojislav Jovanovic, Ivana Marinkovic, Jelena Trifunovic, Danijela Petrovic, Olga Dobric, Milan Aleksandric, Srdjan Juricic, Stefan Boskovic, Nikola Tomasevic, Miloje Ristic, Arsen Orlic, Dejan Stojkovic, Sinisa Vukcevic, Vladan Stankovic, Goran Ostojic, Miodrag Djordjevic Dikic, Ana
Abstract	BackgroundMicrovascular dysfunction might be a major determinant of clinical deterioration and outcome in patients with hypertrophic cardiomyopathy (HCM). However, long‐term prognostic value of transthoracic Doppler echocardiography (TDE) coronary flow velocity reserve (CFVR) on clinical outcome is uncertain in HCM patients. Therefore, the aim of our study was to assess long‐term prognostic value of CFVR on clinical outcome in HCM population.Methods and ResultsWe prospectively included 150 HCM patients (82 women; mean age 48±15 years). Patients’ clinical characteristics, echocardiographic and CFVR findings (both for left anterior descending [LAD] and posterior descending artery [PD]), were assessed in all patients. The primary outcome was a composite of: HCM related death, heart failure requiring hospitalization, sustained ventricular tachycardia and ischemic stroke. Patients were stratified into 2 subgroups depending on CFVR LAD value: Group 1 (CFVR LAD>2, [n=87]) and Group 2 (CFVR LAD≤2, [n=63]). During a median follow‐up of 88 months, 41/150 (27.3%) patients had adverse cardiac events. In Group 1, there were 8/87 (9.2%), whereas in Group 2 there were 33/63 (52.4%, P<0.001 vs. Group 1) adverse cardiac events. By Kaplan‐Meier analysis, patients with preserved CFVR LAD had significantly higher cumulative event‐free survival rate compared to patients with impaired CFVR LAD (96.4% and 90.9% versus 66.9% and 40.0%, at 5 and 8 years, respectively: log‐rank 37.2, P<0.001). Multivariable analysis identified only CFVR LAD≤2 as an independent predictor for adverse cardiac outcome (HR 6.54; 95% CI 2.83–16.30, P<0.001), while CFVR PD was not significantly associated with outcome.ConclusionsIn patients with HCM, impaired CFVR LAD (≤2) is a strong, independent predictor of adverse cardiac outcome. When the aim of testing is HCM risk stratification and CFVR LAD data are available, the evaluation of CFVR PD is redundant.
Page Count	12
Journal	Journal of the American Heart Association
Volume Number	10
PubMed Central reference number	PMC8751885
Issue Number	20
PubMed reference number	34634920
e-ISSN	20479980
DOI	10.1161/jaha.120.021936
Language	English
Publisher	John Wiley and Sons Inc.
Publisher Date	2021-10-12
Publisher Place	Hoboken
Access Restriction	Open
Rights License	This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. © 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
Subject Keyword	adverse cardiac outcome coronary flow velocity reserve hypertrophic cardiomyopathy microvascular dysfunction prognosis Echocardiography Prognosis Imaging Cardiomyopathy Hypertrophy
Content Type	Text
Resource Type	Article
Subject	Cardiology and Cardiovascular Medicine