Predictive scoring method for declining left ventricular ejection fraction in hypertrophic cardiomyopathy

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Abstract Background The transition to the dilated phase, as well as sudden cardiac death, is one of the most undesirable scenarios for patients with hypertrophic cardiomyopathy (HCM). Although the dilated phase of HCM (DHCM) is defined as left ventricular ejection fraction (LVEF) <50%, the significance of mildly reduced LVEF is also in the spotlight because this status is considered as a transitional phase of DHCM. Establishing predictive scoring method for declining LVEF is expected. Methods Of the 319 HCM patients enrolled in the J-HCM registry from our hospital, we analyzed 168 patients (101 male and 57 female, 63.4±14.8 years), after excluding those who underwent PTSMA, who received pacemaker implantation, and who died or dropped out within 2 years. The patients were divided into two groups according to the change of LVEF from the baseline. During the follow-up period (62.0±109.9 months), LVEF decreased by ≥10% in 37 patients (Group D) whereas it did not in 131 patients (Group C). We compared clinical parameters between the two groups to identify the factors affecting the declining LVEF by ≥10% and examined whether the scoring method using those parameters can predict it. Results At the baseline, the percentage of male and diabetic patients was greater in group D than group C (76% vs. 55%, P=0.023 and 38% vs. 12%, P<0.001, respectively). The patients with complete right bundle branch block, wide QRS complex (>100msec), and atrial fibrillation tended to be more in group D than group C (all P<0.1). When the scoring method with those 5 parameters was tested by giving 1 point each, the risk of the declining LVEF was tended to be higher in the patients with 2 or 3 point and significantly higher in those with 4 point compared with that in those with point 0 (OR 2.042, 95% CI 0.983–4.243, P=0.056 and OR 12.000, 95% CI 2.313–62.267, P=0.003, respectively). Conclusions This scoring method appeared to be useful to stratify the risk of the decrease in LVEF in patients with HCM. The validation study is warranted in a larger population. Funding Acknowledgement Type of funding sources: None.

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