Relation of Doppler Tissue Imaging Parameters with Heart Failure Progression in Hypertrophic Cardiomyopathy

• Published in: The American journal of cardiology 2016-06, Vol.117 (11), p.1808-1814
• Main Authors: Kalra, Ankur, MD, Harris, Kevin M., MD, Maron, Bradley A., MD, Maron, Martin S., MD, Garberich, Ross F., MS, Haas, Tammy S., RN, Lesser, John R., MD, Maron, Barry J., MD
• Format: Article
• Language: English
• Subjects: Adult; Cardiomyopathy; Cardiomyopathy, Hypertrophic - complications; Cardiomyopathy, Hypertrophic - diagnosis; Cardiomyopathy, Hypertrophic - physiopathology; Cardiovascular; Diastole; Disease Progression; Doppler effect; Echocardiography, Doppler - methods; Female; Follow-Up Studies; Heart failure; Heart Failure - diagnosis; Heart Failure - etiology; Heart Failure - physiopathology; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; Male; Multivariate analysis; Prognosis; Pulmonary arteries; Retrospective Studies; Stroke Volume; Systole; Time Factors; Velocity; Ventricular Function, Left - physiology
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2016.03.018

Abstract Refractory progressive heart failure (HF) is becoming the predominant cause of mortality in nonobstructive hypertrophic cardiomyopathy (HC). To anticipate development of this important and often unpredictable clinical course, we investigated whether left ventricular diastolic dysfunction, assessed by echocardiographic Doppler parameters, could identify a subset of HC patients without resting obstruction who would experience progression of HF. Diastolic function parameters, assessed by Doppler tissue imaging (DTI), mitral inflow, and pulmonary venous flow were measured in 274 consecutive adult HC patients evaluated from 2003 to 2007. DTI and other diastolic and clinical/demographic parameters were measured against the composite end-point of heart failure/death, heart transplantation or progression to advanced New York Heart Association (NYHA) functional class III/IV symptoms, as well as sudden death/implantable defibrillator (ICD) interventions. HF end-points were reached in 19 of 274 patients (7%) over a follow-up period of 4.0 ± 2.3 years. Variables significantly associated with HF outcome by univariate analysis included male sex, initial New York Heart Association class II, lower ejection fraction, and reduced septal and lateral e´ mitral annular tissue velocities. Multivariable analysis showed only a reduced lateral e′ mitral annular tissue velocity to be independently associated with the composite HF end-points (HR 0.77; 95% CI: 0.65 - 0.91; p=0.003). In addition, estimated pulmonary arterial systolic pressure and extensive late gadolinium enhancement by magnetic resonance were also associated with HF outcome (p = 0.04 and p < 0.001, respectively). No Doppler (or clinical) variable was associated with SD/appropriate ICD interventions. In conclusion, in HC without resting outflow obstruction, diastolic dysfunction evidenced by DTI-reduced lateral e′ mitral annular tissue velocity, was associated with adverse long-term HF outcome, but was unrelated to sudden death. This echocardiographic marker provides a potential noninvasive strategy for anticipating progressive HF in this HC patient group.