Clinical significance of tissue Doppler imaging in patients with hypertrophic cardiomyopathy

Background A transmitral E/septal Ea ratio +/- 15 is a predictor of adverse outcome in cardiac disease, so it was hypothesized that a septal E/Ea >= 15 would predict the risk of adverse outcome, including sustained ventricular tachycardia (VT), cardiac arrest, implantable cardioverter defibrillator (ICD) discharge, or sudden death (SD) in patients with hypertrophic cardiomyopathy (HCM). Methods and Results The study group comprised 96 consecutive patients with HCM (median age 53 years) who completed all noninvasive tests for risk stratification. The endpoint of the study was defined as death, cardiac arrest, documented sustained VT, or ICD-discharge. The median follow-up was 20.6 months. All patients were alive at the end of follow-up, although 8 patients had reached the endpoint during the study period. The variables that were predictive of adverse clinical outcome were family history of premature SD (p=0.03), syncope (p<0.001), maximum wall thickness >= 3cm (p=0.02), and septal E/Ea >= 15 (p<0.001). In a stepwise multivariable model the only independent prognostic indicator was a septal E/Ea :15 (relative risk 0.26, 95% confidence interval 0.2-0.58, p<0.001). The cumulative event-free survival rate was 78.9% in patients with septa] E/Ea >= 15, and 100% in patients with septa] E/Ea <15 (p=0.0003). Conclusions Septal E/Ea >= 15 predicts patients with HCM who are at risk of sustained VT, cardiac arrest, JCD-discharge, or SD.