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Prognostic significance of left ventricular end diastolic pressure using E/E' in patients with hypertrophic cardiomyopathy
Author(s) -
Badran Hala Mahfouz,
Soltan Ghada,
Almeleigi Reda,
Faheem Naglaa,
Yacoub Magdi H.
Publication year - 2019
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.14539
Subject(s) - cardiology , medicine , hypertrophic cardiomyopathy , diastole , pulmonary artery , ventricular outflow tract , blood pressure
Background Left ventricular (LV) diastolic dysfunction is a prominent feature of hypertrophic cardiomyopathy (HCM). Prediction of LV filling pressure using the ratio between early diastolic transmitral flow and mitral annular velocity (E/e') had proved a good accuracy. Aim of this study We investigated the value of E/e' to predict cardiovascular (CV) mortality in patients with HCM. Methods A total of 243 patients with HCM had E/e' measured in combination with clinical evaluation, conventional echocardiographic measurements, cardiopulmonary exercise evaluation, and Holter monitoring. Results During a mean follow‐up of (3.2 ± 1.2 years), 17 (7%) patients died. Non survivors had significantly higher SBP, DBP, left ventricular outflow tract obstruction (LVOTO) gradient, mitral E, and E/e', but lower e' of mitral annulus and more prevalent restrictive filling pattern. E/e' was directly correlated with age ( r = .24, P < .005), left atrial volume index ( r = .44, P < .0001), LVMI (r=0.23, P <.005), LVOT gradient ( r = .43, P < .0001), NYHA class ( r = .19, P < .006), pulmonary artery pressure ( r = .24, P < .005), positive family history of HCM ( r = .22, P < .005), and inversely related to peak systolic velocity (S) ( r = .44, P < .0001). By multivariate analysis, only LVOTO ([RR] 4.11, 95% CI 1.002 to 1.148, P < .04) and E/e' were independent predictors for overall mortality in HCM (relative risk [RR] 5.27, 95% CI 1.002 to 1.024, P < .02). The risk of dying increased with increasing E/e' ratio, being approximately 4 times higher for patients in the highest quartile (HR 3.8 (CI 1.38‐5.12, log‐rank < 0.002)). Conclusions In hypertrophic cardiomyopathy, the E/e' ratio remains a powerful predictor of all‐cause mortality, particularly if it is associated with LVOT obstruction.