Prognostic Implication of Mitral Valve Disease and Its Progression in East Asian Patients With Hypertrophic Cardiomyopathy

Overview

Journal J Am Heart Assoc

Specialty Cardiology & Vascular Diseases

Date 2023 Jan 23

PMID 36688372

Authors

Dae-Young Kim

Jiwon Seo

Iksung Cho

Geu-Ru Hong

Jong-Won Ha

Chi Young Shim

Affiliations

Soon will be listed here.

Abstract

Background Hypertrophic cardiomyopathy (HCM) is a genetic disorder affecting not only the myocardium but also the mitral valve (MV) and its apparatus. This study aimed to investigate the prognostic implication of MV disease and its progression in East Asian patients with HCM. Methods and Results We assessed MV structure and function on the indexed echocardiogram of 1185 patients with HCM (mean±SD age, 60±14 years; men, 67%) in a longitudinal HCM registry, and 667 patients who performed follow-up echocardiogram after 3 to 5 years were also analyzed. Progression of mitral regurgitation (MR) was defined as the increase of at least 1 grade. Clinical outcomes were defined as a composite of cardiovascular death, heart failure hospitalization, MV surgery or septal myectomy, and heart transplantation. Most of the entire cohort was nonobstructive type (n=1081 [91.2%]). A total of 278 patients (23.5%) showed at least mild MR on indexed echocardiogram. MR, systolic anterior motion, and mitral annular calcification were more prevalent in patients with obstructive HCM. During 7.0±4.0 years of follow-up, presence of MR was independently associated with poor clinical outcomes (hazard ratio [HR], 1.60 [95% CI, 1.07-2.40]; =0.023). On follow-up echocardiogram, 67 (10.0%) patients showed MR progression, and it was independently associated with poor prognosis (HR, 2.46 [95% CI, 1.29-4.71]; =0.007). Conclusions In East Asian patients with HCM whose major type is nonobstructive, MV disease is common. MR, systolic anterior motion, and mitral annular calcification are more prevalent in patients with obstructive HCM. The presence and progression of MR are associated with a poor prognosis in patients with HCM.

Citing Articles

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References

Movva R, Murthy K, Romero-Corral A, Rammohan H, Fumo P, Pressman G . Calcification of the mitral valve and annulus: systematic evaluation of effects on valve anatomy and function. J Am Soc Echocardiogr. 2013; 26(10):1135-1142. DOI: 10.1016/j.echo.2013.06.014. View

Grigg L, Wigle E, Williams W, Daniel L, Rakowski H . Transesophageal Doppler echocardiography in obstructive hypertrophic cardiomyopathy: clarification of pathophysiology and importance in intraoperative decision making. J Am Coll Cardiol. 1992; 20(1):42-52. DOI: 10.1016/0735-1097(92)90135-a. View

Ommen S, Mital S, Burke M, Day S, Deswal A, Elliott P . 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2020; 142(25):e558-e631. DOI: 10.1161/CIR.0000000000000937. View

Moon J, Shim C, Ha J, Cho I, Kyung Kang M, Yang W . Clinical and echocardiographic predictors of outcomes in patients with apical hypertrophic cardiomyopathy. Am J Cardiol. 2011; 108(11):1614-9. DOI: 10.1016/j.amjcard.2011.07.024. View

Maron B, Ommen S, Semsarian C, Spirito P, Olivotto I, Maron M . Hypertrophic cardiomyopathy: present and future, with translation into contemporary cardiovascular medicine. J Am Coll Cardiol. 2014; 64(1):83-99. DOI: 10.1016/j.jacc.2014.05.003. View

Ommen S, Maron B, Olivotto I, Maron M, Cecchi F, Betocchi S . Long-term effects of surgical septal myectomy on survival in patients with obstructive hypertrophic cardiomyopathy. J Am Coll Cardiol. 2005; 46(3):470-6. DOI: 10.1016/j.jacc.2005.02.090. View

Simon A, ROSS Jr J, GAULT J . Angiographic anatomy of the left ventricle and mitral valve in idiopathic hypertrophic subaortic stenosis. Circulation. 1967; 36(6):852-67. DOI: 10.1161/01.cir.36.6.852. View

Zoghbi W, Adams D, Bonow R, Enriquez-Sarano M, Foster E, Grayburn P . Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2017; 30(4):303-371. DOI: 10.1016/j.echo.2017.01.007. View

Wigle E, Trimble A, Adelman A, Bigelow W . Surgery in muscular subaortic stenosis. Prog Cardiovasc Dis. 1968; 11(2):83-112. DOI: 10.1016/0033-0620(68)90021-2. View

10.

Puri P, Sarma R, Ostrzega E, Varadarajan P, Pai R . Massive posterior mitral annular calcification causing dynamic left ventricular outflow tract obstruction: mechanism and management implications. J Am Soc Echocardiogr. 2005; 18(10):1106. DOI: 10.1016/j.echo.2005.01.023. View

11.

Maron B, Spirito P, Shen W, Haas T, Formisano F, Link M . Implantable cardioverter-defibrillators and prevention of sudden cardiac death in hypertrophic cardiomyopathy. JAMA. 2007; 298(4):405-12. DOI: 10.1001/jama.298.4.405. View

12.

Ullah W, Haas D, Almas T, Al-Mukhtar A, Inayat A . Caseous mitral valve calcification and concurrent hypertrophic obstructive cardiomyopathy: A rare cause of stroke. Int J Cardiol Heart Vasc. 2020; 30:100647. PMC: 7524529. DOI: 10.1016/j.ijcha.2020.100647. View

13.

Kim D, Shim C, Hong G, Jeong H, Ha J . Morphological and functional characteristics of mitral annular calcification and their relationship to stroke. PLoS One. 2020; 15(1):e0227753. PMC: 6957171. DOI: 10.1371/journal.pone.0227753. View

14.

Nagueh S, Bierig S, Budoff M, Desai M, Dilsizian V, Eidem B . American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with hypertrophic cardiomyopathy: Endorsed by the American Society of Nuclear Cardiology, Society for Cardiovascular Magnetic.... J Am Soc Echocardiogr. 2011; 24(5):473-98. DOI: 10.1016/j.echo.2011.03.006. View

15.

Bertrand P, Churchill T, Yucel E, Namasivayam M, Bernard S, Nagata Y . Prognostic importance of the transmitral pressure gradient in mitral annular calcification with associated mitral valve dysfunction. Eur Heart J. 2020; 41(45):4321-4328. PMC: 7735814. DOI: 10.1093/eurheartj/ehaa819. View

16.

Feneon D, Schnell F, Galli E, Bernard A, Mabo P, Daubert J . Impact of exercise-induced mitral regurgitation on hypertrophic cardiomyopathy outcomes. Eur Heart J Cardiovasc Imaging. 2015; 17(10):1110-7. DOI: 10.1093/ehjci/jev242. View

17.

Kuperstein R, Klempfner R, Ofek E, Maor E, Freimark D, Sternik L . De novo mitral regurgitation as a cause of heart failure exacerbation in patients with hypertrophic cardiomyopathy. Int J Cardiol. 2017; 252:122-127. DOI: 10.1016/j.ijcard.2017.11.060. View

18.

Levine R, Stathogiannis E, Newell J, Harrigan P, Weyman A . Reconsideration of echocardiographic standards for mitral valve prolapse: lack of association between leaflet displacement isolated to the apical four chamber view and independent echocardiographic evidence of abnormality. J Am Coll Cardiol. 1988; 11(5):1010-9. DOI: 10.1016/s0735-1097(98)90059-6. View

19.

Olivotto I, Maron M, Adabag A, Casey S, Vargiu D, Link M . Gender-related differences in the clinical presentation and outcome of hypertrophic cardiomyopathy. J Am Coll Cardiol. 2005; 46(3):480-7. DOI: 10.1016/j.jacc.2005.04.043. View

20.

Patlolla S, Schaff H, Nishimura R, Geske J, Lahr B, Lee A . Mitral Annular Calcification in Obstructive Hypertrophic Cardiomyopathy: Prevalence and Outcomes. Ann Thorac Surg. 2021; 114(5):1679-1687. DOI: 10.1016/j.athoracsur.2021.09.077. View