Background
An appropriate indicator of cardiac function in the risk stratification of hypertrophic
cardiomyopathy (HCM) patients is urgently needed. Cardiac index that reflects cardiac
pumping function may be suitable.
Objective
The purpose of this study was to investigate the clinical significance of reduced
cardiac index in HCM patients.
Methods
A total of 927 HCM patients were enrolled. The primary endpoint was cardiovascular
death. The secondary endpoints were sudden cardiac death (SCD) and all-cause death.
Combination models were constructed by adding reduced cardiac index and reduced left
ventricular ejection fraction (LVEF) to the HCM risk–SCD model. Predictive accuracy
was determined by C-statistics.
Results
Reduced cardiac index was defined as cardiac index ≤2.42 L/min/m2. During median follow-up of 4.3 years, 51 patients reached the endpoint. Reduced
cardiac index independently increased the risk of cardiovascular death (adjusted hazard
ratio [aHR] 2.976; P = .007), SCD (aHR 6.385; P = .001), and all-cause death (aHR 2.428; P = .010). By adding reduced cardiac index to the HCM risk–SCD model, the model C-statistic
increased from 0.691 to 0.762, with an integrated discrimination improvement of 0.021
(P = .018) and a net reclassification improvement of 0.560 (P = .007). The addition of reduced LVEF failed to improve the original model. Better
predictive accuracy for all endpoints was also indicated in reduced cardiac index
than in reduced LVEF.
Conclusion
Reduced cardiac index is an independent predictor of poor prognoses in HCM patients.
Combining reduced cardiac index rather than reduced LVEF improved the HCM risk–SCD
stratification strategy. The reduced cardiac index showed better predictive accuracy
than reduced LVEF for all endpoints.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: March 02, 2023
Publication stage
In Press Journal Pre-ProofFootnotes
Funding Sources: This work was supported by the CAMS Innovation Fund for Medical Sciences (2022-I2M-1-005 and 2020-I2M-C&T-A-006), the Science and Technology Department of Heilongjiang Province (2022ZXJ03C04), and the National Natural Science Foundation of China (82170371).
Disclosures: The authors have no conflicts of interest to disclose.
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