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Value of Echo-Doppler for the
Follow-Up and Prognosis of
Hypertrophic Cardiomyopathy

Candell Riera, Jaume; Romero Farina, Guillermo;
Galve Basilio, Enrique; Palet Balart, Jordi;
Armadans Lluis, Reina María Dolores;
García del Castillo, Herminio;
Soler Soler, Jordi.

Hospital Universitari Vall d´Hebron, Barcelona, España

Introduction: Changes in dynamic gradient, progression of left ventricular hypertrophy in young patients, and dilatation of left ventricular (LV) diameter in adult patients have been observed during follow-up of hypertrophy cardiomyopathy (HC). Only the severity of LV hypertrophy and the dynamic gradient have been previously reported as echo-Doppler predictive markers in HC.

Objective: To assess the value of echo-Doppler for the follow-up and prognosis of a hospital-based series of adult patients with hypertrophy cardiomyopathy (HC).

Methods: One-hundred and nineteen consecutive patients with HC (52 ± 12 years, 60 women) were studied over a follow-up period of 9.7 ± 6.7 years. Echocardiographic evolution was analyzed in 104 patients (67 with dynamic obstruction) who had, at least, two echocardiograms performed within an interval of 3.7 ± 3 years (1 to 7 years).

Results: Fifteen percent of patients without dynamic obstruction in the first echo-Doppler showed a gradient > 25 mmHg in the last echo, and in 5% of patients and increase > 10 mm in LV end diastolic diameter was observed. A greater number of patients with mitral insufficiency (80% vs. 66%; p = 0.01) and an increase in its severity (p = 0.038) were also observed during follow-up. A significant correlation between severity of mitral insufficiency and dynamic gradient (r = 0.40, p = 0.001) was observed. Seven patients died during follow-up and 31 patients developed severe complications (7 death, 15 syncope, 4 class IV angina, 3 class IV dyspnea and 2 acute myocardial infarction). The severity of mitral insufficiency (p = 0.001), dynamic gradient > 50 mmHg (p = 0.02), a septal thickness > 25 mm were predictive of mortality and a left atrial diameter > 45 mm was predictive (p = 0.028) of severe complications.

Discussion: In contrast with other reports based in series of young patients with HC, we did not observe progression of LV hypertrophy. However, dynamic gradient significantly increased in 15% of our patients and in 5% of patients there was a tendency to LV dilatation. As other authors, we confirmed that severity of LV hypertrophy and dynamic gradient were prognostic markers in these patients. However, the severity of mitral insufficiency was the most significant predictive marker of mortality and the left atrial diameter was predictive of severe complications.

Conclusions: An evolution to obstructive forms of HC and a tendency to LV dilatation can be observed in 15% and 5% of patients with HC, respectively. Progression of mitral insufficiency severity also can be observed during follow-up. Severity of mitral insufficiency, dynamic gradient > 50 mmHg, septal thickness > 25 mm and left atrial diameter > 45 mm are variables indicating a worse prognosis in adult patients with HC.



Questions, contributions and commentaries to the authors: send an e-mail message (up to 15 lines,
without attachments) to echo-pcvc@fac.org.ar, written either in English, Spanish, or Portuguese.

2nd Virtual Congress of Cardiology

Dr. Florencio Garófalo
Steering Committee
Dr. Raúl Bretal
Scientific Committee
Dr. Armando Pacher
Technical Committee - CETIFAC

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