E/e′ ratio and outcome prediction in hypertrophic cardiomyopathy: the influence of outflow tract obstruction

• Published in: European heart journal cardiovascular imaging 2018-01, Vol.19 (1), p.101-107
• Main Authors: Lu, Dai-Yin, Haileselassie, Bereketeab, Ventoulis, Ioannis, Liu, Hong-Yun, Liang, Hsin-Yueh, Pozios, Iraklis, Canepa, Marco, Phillip, Susan, Abraham, M Roselle, Abraham, Theodore
• Format: Article
• Language: English
• Subjects: Academic Medical Centers; Adult; Aged; Cardiac Surgical Procedures - methods; Cardiomyopathy, Hypertrophic - diagnostic imaging; Cardiomyopathy, Hypertrophic - epidemiology; Cardiomyopathy, Hypertrophic - surgery; Cohort Studies; Comorbidity; Disease-Free Survival; Echocardiography, Doppler - methods; Female; Follow-Up Studies; Humans; Male; Middle Aged; Myotomy - methods; Patient Selection; Predictive Value of Tests; Retrospective Studies; Risk Assessment; Severity of Illness Index; Survival Analysis; Time Factors; Treatment Outcome; Ventricular Outflow Obstruction - diagnostic imaging; Ventricular Outflow Obstruction - epidemiology; Ventricular Outflow Obstruction - physiopathology
• ISSN: 2047-2404; 2047-2412
• DOI: 10.1093/ehjci/jex134

Abstract Aims Diastolic dysfunction is thought to be an important pathophysiologic component of hypertrophic cardiomyopathy (HCM). However, there are conflicting data on the potential value of the mitral E/e′ ratio. We examined whether left ventricular outflow tract (LVOT) obstruction influences the value of E/e′ in predicting outcomes in HCM. Methods and results Patients who met diagnostic criteria for HCM were enrolled. Diastolic function was assessed with complete two-dimensional and Doppler echocardiography. A composite clinical outcome including new onset atrial fibrillation, sustained ventricular tachycardia/fibrillation, heart failure, transplantation, and death was examined over a mean follow-up period of 4.2 years. Among 604 patients, 206 patients had an E/e′ level ≥20. Patients with higher septal E/e′ level were older, with more severe NYHA class, and more severe LVOT obstruction. Higher E/e′ was associated with worse event-free survival in non-obstructive group and total HCM cohort. In addition, E/e′ and LVOT pressure gradient were highly correlated in non-obstructive and total HCM, but not in labile or obstructive group. During follow-up period, 95 patients underwent myectomy. Post-op E/e′ correlated significantly with LVOT pressure gradient (R = 0.306, P = 0.004). In these patients, post-op E/e′ was associated with worse event-free survival (log-rank P = 0.030). Conclusion Assessment of E/e′ is useful for risk stratification in HCM patients. Nevertheless, the predictive power is confounded by dynamic LVOT obstruction. Higher E/e′ predicts worse clinical outcomes in non-obstructive HCM and in labile/obstructive after myectomy.