Follow-up of patients with genotype positive-phenotype negative hypertrophic cardiomyopathy
P. A. Vriesendorp, A. F. L. Schinkel, M. A. Van Slegtenhorst, M. W. Wessels, F. J. Ten Cate, M. Michels
European Heart Journal
Advances in cardiomyopathies quences and detection of late gadolinium enhancement (LGE) which was used as a marker of early myocardial involvement. Results: Six (14%) patients had LGE, mainly involving apical, mid-basal inferoseptal and basal inferolateral segments. The presence of LGE was significantly higher in the group who had electrocardiographic abnormalities (29% vs. 4%, p <0.05). Of these 6 patients, 3 had regional wall motion abnormalities (2 with isolated apical dyskinesis and 1 with
... ateral hypokinesis). Only one patient showed oedema on STIR sequences suggestive of active inflammatory activity. With CMR as the method of reference, the ECG had a sensitivity of 83% and a negative predictive value of 96% to detect CCM. Conclusion: ECG proves to be a useful, inexpensive and globally available tool for the screening of CCM in asymptomatic patients but with proven myocardial involvement in the CRM. Introduction: Takotsubo cardiomyopathy (TC) is characterized by a transient left ventricular (LV) dysfunction. The predictors of prognosis in TC are not yet fully established. Purpose: To identify predictors of outcome in patients (P) diagnosed with TC. Methods: Multicenter study involving 5 hospital centers that included all patients diagnosed with TC in the last 10 years. We assessed demographic data, precipitating factors and clinical presentation, trying to establish the predictors of in-hospital and post-discharge outcomes. Results: We included 67 P diagnosed with TC. During hospitalization (5.9±4.2 days) the following complications ocurred: heart failure (29.9%), cardiogenic shock (14.9%), atrial fibrillation (9%), complete atrioventricular block (4.5%), acute pulmonary edema (3%), stroke/TIA (3%), LV thrombus (1.5%) and death (1.5%). The following variables were identified as predictors of in-hospital complications: (i) Predictors of complete atrioventricular block were angina pectoris (p=0,047), syncope at presentation (p=0,043) and ST segment elevation on the admission EKG (p=0,015); (ii) ST segment depression on the admission EKG was identified as a predictor of acute pulmonary edema (p=0,011); (iii) LV dysfunction was an independent predictor of heart failure (p=0,011) and stroke/TIA (p=0,049); (iv) Male gender was an independent predictor of stroke/TIA (p=0,048) and death (p=0,002); (v) Other predictors of death were diabetes mellitus (p=0,024) and chronic renal failure (p=0,025). Over a follow-up of 32±28 months, the following events occurred: TC recurrence (4.5%), stroke/TIA (4.5%) and death (1.5%). The following variables were identified as predictors of complications during follow-up: (i) ST segment depression on admission EKG was a predictor of TC recurrence (p=0,016); (ii) Predictors of stroke/TIA were chronic renal failure (p=0,002) and absence of ST depression on admission EKG (p=0,016); (iii) Chronic renal failure was a predictor of death (p=0,009). Conclusion: TC has a high rate of complications in the acute phase, but a low rate of complications during follow-up. TC, mainly a disease of females, has a worse in-hospital prognosis in males. Male gender is a predictor of in-hospital stroke/TIA and death. Diabetes and chronic renal failure were also predictors of in-hospital death and chronic renal failure continues to be a predictor of death and also of stroke during follow-up. The admission EKG may have a prognostic role and ST segment depression was the only identified predictor of TC recurrence. Our results need confirmation in larger studies.