Wei Hua
Fuwai Hospital & Cardiovascular Institute, China
Title: The clinical outcome of cardiac resynchronization therapy in dilated-phase hypertrophic cardiomyopathy
Biography
Biography: Wei Hua
Abstract
Statement of the Problem: Clinical trials have demonstrated that cardiac resynchronization therapy (CRT) is effective in patients with non-ischemic cardiomyopathy. However, patients with dilated-phase hypertrophic cardiomyopathy (DHCM) have been generally excluded from such trials. We aimed to compare the clinical outcome of CRT in patients with DHCM, idiopathic dilated cardiomyopathy (IDCM) or ischemic cardiomyopathy (ICM).
Methodology & Theoretical Orientation: A total of 312 consecutive patients (DHCM=16; IDCM=231; ICM=65) undergoing CRT in Fuwai hospital were studied respectively. Response to CRT was defined as reduction in left ventricular end-systolic volume (LVESV) ≥15% at six-month follow-up.
Findings: Compared with DHCM, IDCM was associated with a lower total mortality [hazards ratio, HR: 0.35 (95% confidence interval, CI 0.13-0.90)], cardiac mortality [HR: 0.29 (95% CI 0.11-0.77)] and total mortality or heart failure (HF) hospitalizations [HR: 0.34 (95% CI 0.17-0.69)], independent of known confounders. Compared with DHCM, the total mortality, cardiac mortality and total mortality or HF hospitalizations favored ICM but were not statistically significant. [HR: 0.59 (95% CI 0.22-1.61); HR: 0.59 (95% CI 0.21-1.63); HR: 0.54 (95% CI 0.26–1.15) respectively]. Response rate to CRT was lower in the DHCM group than the other two groups although the differences didn't reach statistical significance.
Conclusion & Significance: Compared with IDCM, DHCM was associated with a worse outcome after CRT; the clinical outcome of DHCM patients receiving CRT was similar to or even worse than that of ICM patients. These indicate that DHCM behaves very differently after CRT.
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REFERENCES:
1. Hua W, Zhang LF, Wu YF, et al.( 2009) Incidence of sudden cardiac death in China: analysis of 4 regional populations. J Am Coll Cardiol. Sep 15;54(12):1110-8.
2. Yi-Zhou Xu, Yong-Mei Cha, Dali Feng, Wei HUA, et al.( 2012) Impact of Myocardial Scarring on Outcomes of Cardiac Resynchronization Therapy: Extent or Location? J Nucl Med 2012; 53:47-54
3. Hua wei. (2010)Cardiac resynchronization therapy for chronic heart failure in China：guideline and practice(Editorial).Chinese Medical Journal ,123(17): 2293-2294.
4. HUA Wei, HONGXIA Niu, XIAOHAN Fan, et al. (2012) Preventive Effectiveness of Implantable Cardioverter Defibrillator in Reducing Sudden Cardiac Death in the Chinese Population: A Multicenter Trial of ICD Therapy versus Non-ICD Therapy. JCE, 2012, 23(S1): S5-S9
5. HUA Wei, WANG Dong-mei, CAI Lin, et al. (2012) A prospective study to evaluate the efficacy of an intracardiac electrogram-based atrioventricular and interventricular intervals optimization method in cardiac resynchronization therapy. Chinese Medical Journal. 2012, 125(3): 428-433