Clinical Correlates and Prognostic Value of Elevated Right Atrial Pressure in Patients With Hypertrophic Cardiomyopathy

被引:8
作者
McCullough, Stephen A. [1 ]
Fifer, Michael A. [1 ]
Mohajer, Pouya [1 ]
Lowry, Patricia A. [1 ]
Reen, Caitlin O'Callaghan [1 ]
Baggish, Aaron L. [1 ]
Vlahakes, Gus J. [2 ]
Shimada, Yuichi J. [1 ,3 ]
机构
[1] Massachusetts Gen Hosp, Dept Med, Div Cardiol, Boston, MA 02114 USA
[2] Massachusetts Gen Hosp, Dept Surg, Cardiac Surg Div, Boston, MA 02114 USA
[3] Columbia Univ, Dept Med, Med Ctr, Div Cardiol, New York, NY 10032 USA
关键词
Atrial fibrillation; Hypertrophic cardiomyopathy; Mortality; Right atrial pressure; RIGHT-VENTRICULAR DYSFUNCTION; HEART-FAILURE; FIBRILLATION; MANAGEMENT; PREVALENCE;
D O I
10.1253/circj.CJ-17-0959
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: The clinical characteristics associated with elevated right atrial pressure (RAP) in hypertrophic cardiomyopathy (HCM) are unknown. Few data exist as to whether elevated RAP has prognostic implications in patients with HCM. This study investigated the clinical correlates and prognostic value of elevated RAP in HCM. Methods and Results: This retrospective cohort study was performed on 180 patients with HCM who underwent right heart catheterization between 1997 and 2014. Elevated RAP was defined as >8 mmHg. Baseline characteristics, mean pulmonary artery pressure, and mean pulmonary capillary wedge pressure (PCWP) were assessed for association with elevated RAP. The predictive value of elevated RAP for all-cause mortality and the development of atrial fibrillation (AF), ventricular tachycardia/fibrillation (VT/VF), and stroke was evaluated. Elevated RAP was associated with higher New York Heart Association class, dyspnea on exertion, orthopnea, edema, jugular venous distention, larger left atrial size, right ventricular hypertrophy, higher pulmonary artery pressure, and higher PCWP. RAP independently predicted all-cause mortality (adjusted hazard ratio [aHR] 2.18 per 5-mmHg increase, 95% confidence interval [CI] 1.05-4.50, P=0.04) and incident AF (aHR 1.85 per 5-mmHg increase, 95% CI 1.20-2.85, P=0.005). Elevated RAP did not predict VT/VF (P=0.36) or stroke (P=0.28). Conclusions: Elevated RAP in patients with HCM is associated with left-sided heart failure and is an independent predictor of all-cause mortality and new-onset AF.
引用
收藏
页码:1405 / 1411
页数:7
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