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Left ventricular ejection fraction as a predictor of major ventricular arrhythmic events in hypertrophic cardiomyopathy patients with an ICD in primary prevention
Session:
SESSÃO DE POSTERS 57 - MIOCARDIOPATIA HIPERTRÓFICA
Speaker:
Miguel Marques Antunes
Congress:
CPC 2025
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.2 Myocardial Disease – Epidemiology, Prognosis, Outcome
Session Type:
Cartazes
FP Number:
---
Authors:
Miguel Marques Antunes; Ricardo Carvalheiro; José Miguel Viegas; Inês Gracio Almeida; Hélder Santos; Guilherme Portugal; Bruno Tereno Valente; Ana Lousinha; Pedro Silva Cunha; Rui Cruz Ferreira; Mário Martins Oliveira; Sílvia Aguiar Rosa
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Background:</span></strong><span style="font-family:"Arial",sans-serif"> Hypertrophic cardiomyopathy (HCM) is a prevalent and potentially life-threatening condition. Prediction of sudden cardiac death (SCD) and ventricular arrythmias (VA) in this heightened-risk population and its prevention with implantable cardiac defibrillators (ICDs) remains sub-optimal. Left ventricular ejection fraction (LVEF) is supra-normal in patients (P) with HCM, and an LVEF <50% traditionally constitutes a known risk enhancer for ventricular events in these P – being a readily available and reproducible tool.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Aim:</span></strong><span style="font-family:"Arial",sans-serif"> To evaluate the impact of progressive LVEF depression in HCM P with an ICD in primary prevention, in comparison to other known predictors.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Methods:</span></strong><span style="font-family:"Arial",sans-serif"> We retrospectively analyzed data from P followed at a Cardiomyopathy Clinic with an ICD in primary prevention. Patients were stratified according to their baseline SCD risk. </span><span style="font-family:"Arial",sans-serif">The primary outcome was an appropriate ICD-delivered therapy, (shock or anti-tachycardia pacing.</span><span style="font-family:"Arial",sans-serif"> We performed a time-to-event analysis using a Cox proportional hazards regression model, to determine predictors of appropriate ICD therapy.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Results:</span></strong><span style="font-family:"Arial",sans-serif"> 52 consecutive P with HCM and an ICD in primary prevention – 46 transvenous ICDs and 8 S-ICDs – were included. Median patient age at implantation was 52 [42-64] years; 33 (63%) were male. Median P follow-up was 2.2 [1.2-3.5] years at risk, with follow-up time ranging from 1 to 155 months. The primary outcome of appropriate ICD activation was met in 6 (12%) P – five shocks and one anti-tachycardia pacing. The observed rhythms were three VF (50%) and three VT (50%). Median HCM SCD risk score was 4.39% </span><span style="font-family:"Arial",sans-serif">[3.33 - 6.20]</span><span style="font-family:"Arial",sans-serif">. Patients that met the primary outcome had the following HCM SCD score distribution – High: 3; Intermediate:1; Low:2. P that experienced VA were younger (45y vs 54y) and more likely to be male (83% vs. 61%). Clinical heart failure was more prevalent in P with arrhythmic events (83% vs 7%), which was compatible with a higher ACEi/ARNi (67% vs 24%) and MRA (83% vs 17%) use in this patient group. LVEF was identified as the strongest predictor of the primary outcome. A 1% increase in LVEF was associated with an 8% reduction in the risk of ICD activation - HR 0.92 (95%CI 0.85-0.99, p=0.03).</span></span></span><br /> <span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Arial",sans-serif"><strong>Conclusion:</strong> In an HCM patient cohort at primary prevention with a median follow up time of 2.2 years the incidence of appropriate ICD activation was 12%. LV dysfunction was the strongest predictor of major ventricular arrhythmic events.</span></span></span></p>
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